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Old -Time Makers of Medicine 



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Makers of Medicine 





James J. Walsh, K.C.St.G, M.D. 

Ph.D., LL.D.. Litt.D.. Sc.D. 









THE historical material here presented was gathered 
for my classes at Fordham University School of Medi 
cine during your term as president of the University. 
It seems only fitting then, that when put into more 
permanent form it should appear under the patronage 
of your name and tell of my cordial appreciation of 
more than a quarter of a century of valued friendship. 

" When we have thoroughly mastered contem 
porary science it is time to turn to past science; 
nothing fortifies the judgment more than this com 
parative study; impartiality of mind is developed 
thereby, the uncertainties of any system become 
manifest. The authority of facts is there confirmed, 
and we discover in the whole picture a philosophic 
teaching which is in itself a lesson; in other words, 
we learn to know, to understand, and to judge." 
LITTRE: (Euvres d Hippocrate, T. I, p. 477. 

There is not a single development, even the most 
advanced of contemporary medicine, which is not to 
be found in embryo in the medicine of the olden 
time." -LITTR: Introduction to the Works of Hip 

" How true it is that in reading this history one 
finds modern discoveries that are anything but dis 
coveries, unless one supposes that they have been 
made twice." -DUJABDIN: Histoire de la Chirurgie, 
Paris, 177-4 (quoted by Gurlt on the post title-page 
of his Gescliiclite der Chirurgie, Berlin, 1898). 


The material for this book was gathered partly 
for lectures on the history of medicine at Fordham 
University School of Medicine, and partly for 
articles on a number of subjects in the Catholic En 
cyclopedia. Some of it was developed for a series 
of addresses at commencements of medical schools 
and before medical societies, on the general topic 
how old the new is in surgery, medicine, dentistry, 
and pharmacy. The information thus presented 
aroused so much interest, the accomplishments of 
the physicians and surgeons of a period that is usu 
ally thought quite sterile in medical science proved, 
indeed, so astonishing, that I was tempted to con 
nect the details for a volume in the Fordham Uni 
versity Press series. There is no pretence to any 
original investigation in the history of medicine, nor 
to any extended consultation of original documents. 
I have had most of the great books that are men 
tioned in the course of this volume in my hands, and 
have given as much time to the study of them as 
could be afforded in the midst of a rather busy life, 
but I owe my information mainly to the distin 
guished German and French scholars who have in 
recent years made deep and serious studies of these 
Old Makers of Medicine, and I have made my ac 
knowledgments to them in the text as opportunity 
presented itself. 

There is just one feature of the book that may 


commend it to present-day readers, and that is that 
our medieval medical colleagues, when medicine em 
braced most of science, faced the problems of medi 
cine and surgery and the allied sciences that are 
now interesting us, in very much the same temper 
of mind as we do, and very often anticipated our 
solutions of them much oftener, indeed, than most 
of us, unless we have paid special attention to 
history, have any idea of. The volume does not 
constitute, then, a contribution to that theme that 
has interested the last few generations so much, 
the supposed continuous progress of the race and 
its marvellous advance, but rather emphasizes that 
puzzling question, how is it that men make im 
portant discoveries and inventions, and then, after 
a time, forget about them so that they have to be 
made over again ? This is as true in medical science 
and in medical practice as in every other depart 
ment of human effort. It does not seem possible 
that mankind should ever lose sight of the progress 
in medicine and surgery that has been made in re 
cent years, yet the history of the past would seem to 
indicate that, in spite of its unlikelihood, it might 
well come about. Whether this is the lesson of the 
book or not, I shall leave readers to judge, for it was 
not intentionally put into it. 







IV. MAIMONIDES ... ... 90 




SITIES ... . 234 











" Of making many books there is no end." 
Eccles. xii, 12 (circa 1000 B.C.). 

The little by-play between Socrates and Euthy- 
demus suggests an advanced condition of medical 
literature : Of course, you who have so many books 
are going in for being a doctor, says Socrates, and 
then he adds, there are so many books on medi 
cine, you know. As Dyer remarks, whatever the 
quality of these books may have been, their number 
must have been great to give point to this chaff." 
Aequanimita.s, WILLIAM OSLEE, M.D., F.R.S., Blakis- 
tons, Philadelphia, 1906. 

i . 

Augescunt aliae gentes, aliae minimntur ; 
Inque brevi spatio mutantur saecla animantum, 
Et, quasi cursores vitai lampada tradunt." 


One nation rises to supreme power in the world, 
while another declines, and, in a brief space of time, 
the sovereign people change, transmitting, like 
racers, the lamp of life to some other that is to suc 
ceed them. 

" There is one Science of Medicine which is con 
cerned with the inspection of health equally in all 
times, present, past and future." 



Under the term Old-Time Medicine most people 
probably think at once of Greek medicine, since that 
developed in what we have called ancient history, 
and is farthest away from us in date. As a matter 
of fact, however, much more is known about Greek 
medical writers than those of any other period ex 
cept the last century or two. Our histories of medi 
cine discuss Greek medicine at considerable length 
and practically all of the great makers of medicine 
in subsequent generations have been influenced by 
the Greeks. Greek physicians whose works have 
come down to us seem nearer to us than the medical 
writers of any but the last few centuries. As a con 
sequence we know and appreciate very well as a rule 
how much Greek medicine accomplished, but in our 
admiration for the diligent observation and breadth 
of view of the Greeks, we are sometimes prone to 
think that most of the intervening generations down 
to comparatively recent times made very little 
progress and, indeed, scarcely retained what the 
Greeks had done. The Romans certainly justify 
this assumption of non-accomplishment in medicine, 
but then in everything intellectual Rome was never 
much better than a weak copy of Greek thought. In 
science the Romans did nothing at all worth while 
talking about. All their medicine they borrowed 


from the Greeks, adding nothing of their own. What 
food for thought there is in the fact, that in spite 
of all Rome s material greatness and wide empire, 
her world dominance and vaunted prosperity, we 
have not a single great original scientific thought 
from a Roman. 

Though so much nearer in time medieval medicine 
seems much farther away from us than is Greek 
medicine. Most of us are quite sure that the im 
pression of distance is due to its almost total lack 
of significance. It is with the idea of showing that 
the medieval generations, as far as was possible in 
their conditions, not only preserved the old Greek 
medicine for us in spite of the most untoward cir 
cumstances, but also tried to do whatever they could 
for its development, and actually did much more 
than is usually thought, that this story of " Old- 
Time Makers of Medicine " is written. It repre 
sents a period that of the Middle Ages that is, or 
was until recently, probably more misunderstood 
than any other in human history. The purpose of 
the book is to show at least the important head 
lands that lie along the stream of medical thought 
during the somewhat more than a thousand years 
from the fall of the Roman Empire under Augus- 
tulus (476) until the discovery of America. After 
that comes modern medicine, for with the sixteenth 
century the names and achievements of the workers 
in medicine are familiar Paracelsus, Vesalius, Co 
lumbus, Servetus, Ca?salpinus, Eustachius, Varolius, 
Sylvius are men whose names are attached to great 
discoveries with which even those who are without 
any pretence to knowledge of medical history are 


not unacquainted. In spite of nearly four centuries 
of distance in time these men seem very close to us. 
Their lives will be reserved for a subsequent volume, 
" Our Forefathers in Medicine." 

It is usually the custom to contemn the Middle 
Ages for their lack of interest in culture, in educa 
tion, in literature, in a word, in intellectual accom 
plishment of any and every kind, but especially in 
science. There is no doubt about the occurrence of 
marked decadence in the intellectual life of the first 
half of this period. This has sometimes been at 
tributed to what has been called the inhibitory effect 
of Christianity on worldly interests. Keligion is 
said to have occupied people so much with thoughts 
of the other world that the beauties and wonders, as 
well as much of the significance, of the world around 
them were missed. Those who talk thus, however, 
forget entirely the circumstances which brought 
about the serious decadence of interest in culture 
and science at this time. The Eoman Empire had 
been the guardian of letters and education and 
science. While the Romans were not original in 
themselves, at least they had shown intense interest 
in what was accomplished by the Greeks and their 
imitation had often risen to heights that made them 
worthy of consideration for themselves. They were 
liberal patrons of Greek art and of Greek literature, 
and did not neglect Greek science and Greek medi 
cine. Galen s influence was due much more to the 
prominence secured by him as the result of his stay 
in Rome than would have been possible had he 
stayed in Asia. There are many other examples of 
Roman patronage of literature and science that 


might be mentioned. As we shall see, Eome drained 
Greece and Asia Minor of their best, and appropri 
ated to herself the genius products of the Spanish 
Peninsula. Rome had a way of absorbing what was 
best in the provinces for herself. 

Just as soon as Rome was cut off from intimate 
relations with the provinces by the inwandering of 
barbarians, intellectual decadence began. The im 
perial city itself had never been the source of great 
intellectual achievement, and the men whom we think 
of as important contributors to Rome s literature 
and philosophy were usually not born within the 
confines of the city. It is surprising to take a list 
of the names of the Latin writers whom we are ac 
customed to set down simply as Romans and note 
their birthplaces. Rome herself gave birth to but 
a very small percentage of them. Virgil was born 
at Mantua, Cicero at Arpinum, Horace out on the 
Sabine farm, the Plinys out of the city, Terence in 
Africa, Persius up in Central Italy somewhere, Livy 
at Padua, Martial, Quintilian, the Senecas, and 
Lucan in Spain. When the government of the city 
ceased to be such as assured opportunity for those 
from outside who wanted to make their way, deca 
dence came to Roman literature. Large cities have 
never in history been the fruitful mothers of men 
who did great things. Genius, and even talent, has 
always been born out of the cities in which it did 
its work. It is easy to understand, then, the deca 
dence of the intellectual life that took place as the 
Empire degenerated. 

For the sake of all that it meant in the Roman 
Empire to look towards Rome at this time, however, 


it seemed better to the early Christians to establish 
the centre of their jurisdiction there. Necessarily, 
then, in all that related to the purely intellectual life, 
they came under the influences that were at work at 
Rome at this time. During the first centuries they 
suffered besides from the persecutions directed 
against them by the Emperors at various times, and 
these effectually prevented any external manifesta 
tions of the intellectual life on the part of Christians. 
It took much to overcome this serious handicap, but 
noteworthy progress was made in spite of obstacles, 
and by the time of Constantine many important of 
ficials of the Empire, the educated thinking classes 
of Rome, had become Christians. After the conver 
sion of the Emperor opportunities began to be af 
forded, but political disturbances consequent upon 
barbarian influences still further weakened the old 
civilization until much of the intellectual life of it 
almost disappeared. 

Gradually the barbarians, finding the Roman Em 
pire decadent, crept in on it, and though much more 
of the invasion was peaceful than we have been ac 
customed to think, the Romans simply disappearing 
because family life had been destroyed, children had 
become infrequent, and divorce had become ex 
tremely common, it was not long before they re 
placed the Romans almost entirely. These new peo 
ples had no heritage of culture, no interest in the 
intellectual life, no traditions of literature or 
science, and they had to be gradually lifted up out 
of their barbarism. This was the task that Chris 
tianity had to perform. That it succeeded in ac 
complishing it is one of the marvels of history. 


The Church s first grave duty was the preserva 
tion of the old records of literature and of science. 
Fortunately the monasteries accomplished this task, 
which would have been extremely perilous for the 
precious treasures involved but for the favorable 
conditions thus afforded. Libraries up to this time 
were situated mainly in cities, and were subject to 
all the vicissitudes of fire and war and other modes 
of destruction that came to cities in this disturbed 
period. Monasteries, however, were usually situ 
ated in the country, were built very substantially 
and very simply, and the life in them formed the 
best possible safeguard against fire, which worked 
so much havoc in cities. As we shall see, however, 
not only were the old records preserved, but ex 
cerpts from them were collated and discussed and 
applied by means of direct observation. This led 
the generations to realize more and more the value 
of the old Greek medicine and made them take 
further precautions for its preservation. 

The decadence of the early Middle Ages was due 
to the natural shifting of masses of population of 
this time, while the salvation of scientific and liter 
ary traditions was due to the one stable element in 
all these centuries the Church. Far from Chris 
tianity inhibiting culture, it was the most important 
factor for its preservation, and it provided the best 
stimulus and incentive for its renewed development 
just as soon as the barbarous peoples were brought 
to a state of mind to appreciate it. 

Bearing this in mind, it is easier to understand 
the course of medical traditions through the Middle 
Ages, and especially in the earlier period, with re- 


gard to which our documents are comparatively 
scanty, and during which the disturbed conditions 
made medical developments impossible, and any 
thing more than the preservation of the old authors 
out of the question. The torch of medical illumina 
tion lighted at the great Greek fires passes from 
people to people, never quenched, though often burn 
ing low because of unfavorable conditions, but some 
times with new fuel added to its flame by the con 
tributions of genius. The early Christians took it 
up and kept it lighted, and, with the Jewish physi 
cians, carried it through the troublous times of the 
end of the old order, and then passed it on for a 
while to the Arabs. Then, when favorable condi 
tions had developed again, Christian schools and 
scholars gave it the opportunity to burn brightly 
for several centuries at the end of the Middle Ages. 
This medieval age is probably the most difficult 
period of medical history to understand properly, 
but it is worth while taking the trouble to follow 
out the thread of medical tradition from the Greeks 
to the Renaissance medical writers, who practically 
begin modern medicine for us. 

It is easy to understand that Christianity s in 
fluence on medicine, instead of hampering, was most 
favorable. The Founder of Christianity Himself 
had gone about healing the sick, and care for the 
ailing became a prominent feature of Christian 
work. One of the Evangelists, St. Luke, was a 
physician. It was the custom a generation ago, and 
even later, when the Higher Criticism became pop 
ular, to impugn the tradition as to St. Luke having 
been a physician, but this has all been undone, and 


Harnack s recent book, " Luke the Physician," 
makes it very clear that not only the Third Gospel, 
but also the Acts, could only have been written by a 
man thoroughly familiar with the Greek medical 
terms of his time, and who had surely had the ad 
vantage of a training in the medical sciences at 
Alexandria. This makes such an important link 
in medical traditions that a special chapter has been 
devoted to it in the Appendix. 

Very early in Christianity care for the ailing poor 
was taken up, and hospitals in our modern sense 
of the term became common in Christian com 
munities. There had been military hospitals before 
this, and places where those who could afford to 
pay for service were kept during illness. Our mod 
ern city hospital, however, is a Christian institution. 
Besides, deformed and ailing children were cared 
for and homes for foundlings were established. Be 
fore Christianity the power even of life and death of 
the parents over their children was recognized, 
and deformed or ailing children, or those that for 
some reason were not wanted, were exposed until 
they died. Christianity put an end to this, and in 
two classes of institutions, the hospitals and the 
asylums, abundant opportunity for observation of 
illness was afforded. Just as soon as Christianity 
came to be free to establish its institutions publicly, 
hospitals became very common. The Emperor 
Julian, usually known as the Apostate, who hoped 
to re-establish the old Roman Olympian religion, 
wrote to Oribasius, one of the great physicians of 
this time, who was also an important official of his 
household, that these Christians had established 


everywhere hospitals in which not only their own 
people, but also those who were not Christians, were 
received and cared for, and that it would be idle to 
hope to counteract the influence of Christianity until 
corresponding institutions could be erected by the 

From the very beginning, or, at least, just as soon 
as reasonable freedom from persecution gave op 
portunity for study, Christian interest in the med 
ical sciences began to manifest itself. Nemesius, 
for instance, a Bishop of Edessa in Syria, wrote 
toward the end of the fourth century a little work 
in Greek on the nature of man, which is a striking 
illustration of this. Nemesius was what in modern 
times would be called a philosopher, that is, a spec 
ulative thinker and writer, with regard to man s 
nature, rather than a physical scientist. He was 
convinced, however, that true philosophy ought to 
be based on a complete knowledge of man, body and 
soul, and that the anatomy of his body ought to be a 
fundamental principle. It is in this little volume 
that some enthusiastic students have found a de 
scription that is to them at least much more than a 
hint of knowledge of the circulation of the blood. 
Hyrtl doubts that the passage in question should 
be made to signify as much as has been suggested, 
but the occurrence of any even distant reference to 
such a subject at this time shows that, far from there 
being neglect of physical scientific questions, men 
were thinking seriously about them. 

Just as soon as Christianity brought in a more 
peaceful state of affairs and had so influenced the 
mass of the people that its place in the intellectual 


life could be felt, there comes a period of cultural 
development represented in philosophy by the 
Fathers of the Church, and during which we have a 
series of important contributors to medical litera 
ture. The first of these was Ae tius, whose career 
and works are treated more fully in the chapter on 
" Great Physicians in Early Christian Times." He 
was followed by Alexander of Tralles, probably a 
Christian, for his brother was the architect of Santa 
Sophia, and by Paul of ^Egina, with regard to whom 
we know only what is contained in his medical 
writings, but whose contemporaries were nearly all 
Christians. Their books are valuable to us, partly 
because they contain quotations from great Greek 
writers on medicine, not always otherwise available, 
but also because they were men who evidently knew 
the subject of medicine broadly and thoroughly, 
made observations for themselves, and controlled 
what they learned from the Greek forefathers in 
medicine by their own experience. Just at the be 
ginning of the Middle Ages, then, under the foster 
ing care of Christianity there is a period of consid 
erable importance in the history of medical litera 
ture. It is one of the best proofs that we have not 
only that Christianity did not hamper medical de 
velopment, but that, directly and indirectly, by the 
place that it gave to the care of the ailing in life as 
well as the encouragement afforded to the intel 
lectual life, it favored medical study and writing. 

A very interesting chapter in the story of the 
early Christian physician is to be found in what we 
know of the existence of women physicians in the 
fourth and fifth centuries. Theodosia, the mother 


of St. Procopius the martyr, was, according to 
Carptzovius, looked upon as an excellent physician 
in Rome in the early part of the fourth century. She 
suffered martyrdom under Diocletian. There was 
also a Nicerata who practised at Constantinople un 
der the Emperor Arcadius. It is said that to her 
St. John Chrysostom owed the cure of a serious ill 
ness. From the very beginning Christian women 
acted as nurses, and deaconesses were put in charge 
of hospitals. Fabiola, at Rome, is the foundress of 
the first important hospital in that city. The story 
of these early Christian women physicians has been 
touched upon in the chapter on " Medieval Women 
Physicians," as an introduction to this interesting 
feature of Salernitan medical education. 

During the early Christian centuries much was 
owed to the genius and the devotion to medicine of 
distinguished Jewish physicians. Their sacred and 
rabbinical writers always concerned themselves 
closely with medicine, and both the Old Testament 
and the Talmud must be considered as containing 
chapters important for the medical history of the 
periods in which they were written. At all times 
the Jews have been distinguished for their knowl 
edge of medicine, and all during the Middle Ages 
they are to be found prominent as physicians. They 
were among the teachers of the Arabs in the East 
and of the Moors in Spain. They were probably 
among the first professors at Salerno as well as at 
Montpellier. Many prominent rulers and ecclesi 
astics selected Jewish physicians. Some of these 
made distinct contributions to medicine, and a num 
ber of them deserve a place in any account of medi- 


cine in the making during the Middle Ages. One of 
them, Maimonides, to whom a special chapter is de 
voted, deserves a place among the great makers of 
medicine of all time, because of the influence that 
he exerted on his own and succeeding generations. 
Any story of the preservation and development of 
medical teaching and medical practice during the 
Middle Ages would be decidedly incomplete without 
due consideration of the work of Jewish physicians. 
Western medical literature followed Roman lit 
erature in other departments, and had only the 
Greek traditions at second hand. During the dis 
turbance occasioned by the invasion of the barbari 
ans there was little opportunity for such leisure as 
would enable men to devote themselves with tran 
quillity to medical study and writing. Medical tradi 
tions were mainly preserved in the monasteries. 
Cassiodorus, who, after having been Imperial Prime 
Minister, became a monk, recommended particularly 
the study of medicine to the monastic brethren. 
With the foundation of the Benedictines, medicine 
became one of the favorite studies of the monks, 
partly for the sake of the health of the brethren 
themselves, and partly in order that they might be 
helpful to the villages that so often gathered round 
their monasteries. There is a well-grounded tradi 
tion that at Monte Cassino medical teaching was one 
of the features of the education provided there by 
the monks. It is generally conceded that the Bene 
dictines had much to do with the foundation of 
Salerno. In the convents for women as well as the 
monasteries for men serious attention was given to 
medicine. Women studied medicine and were pro- 


fessors in the medical department of Salerno. Other 
Italian universities followed the example thus set, 
and so there is abundant material for the chapter on 
" Medieval Women Physicians." 

The next phase of medical history in the medieval 
period brings us to the Arabs. Utterly uninterested 
in culture, education, or science before the time of 
Mohammed, with the growth of their political power 
and the foundation of their capitals, the Arab 
Caliphs took up the patronage of education. They 
were the rulers of the cities of Asia Minor in which 
Greek culture had taken so firm a hold, and captive 
Greece has always led its captors captive. With 
the leisure that came for study, Arabians took up 
the cultivation of the Greek philosophers, especially 
Aristotle, and soon turned their attention also to the 
Greek physicians Hippocrates and Galen. For some 
four hundred years then they were in the best posi 
tion to carry on medical traditions. Their teachers 
were the Christian and Jewish physicians of the 
cities of Asia Minor, but soon they themselves be 
came distinguished for their attainments, and for 
their medical writings. Interestingly enough, more 
of their distinguished men flourished in Spain than 
in Asia Minor. We have suggested an explanation 
for this in the fact that Spain had been one of the 
most cultured provinces of the Koman Empire, pro 
viding practically all the writers of the Silver Age 
of Latin literature, and evidently possessing a 
widely cultured people. It was into this province, 
not yet utterly decadent from the presence of the 
northern Goths, that the Moors came and readily 
built up a magnificent structure of culture and edu- 


cation on what had been the highest development of 
Roman civilization. 

The influence of the Arabs on Western civiliza 
tion, and especially on the development of science 
in Europe, has been much exaggerated by certain 
writers. Closely in touch with Greek thought and 
Greek literature during the eighth, ninth, and tenth 
centuries, it is easy to understand that the Arabian 
writers were far ahead of the Christian scholars of 
Europe of the same period, who were struggling up 
out of the practical chaos that had been created by 
the coming of the barbarians, and who, besides, had 
the chance for whatever Greek learning came to 
them only through the secondary channels of the 
Latin writers. Rome had been too occupied with 
politics and aggrandizement ever to become cul 
tured. In spite of this heritage from the Greeks, 
decadence took place among the Arabs, and, as the 
centuries go on, what they do becomes more and 
more trivial, and their writing has less significance. 
Just the opposite happened in Europe. There, there 
was noteworthy progressive development until the 
magnificent climax of thirteenth century accomplish 
ment was reached. It is often said that Europe 
owed much to the Arabs for this, but careful analysis 
of the factors in that progress shows that very lit 
tle came from the Arabs that was good, while not 
a little that was unfortunate in its influence was bor 
rowed from them with the translations of the Greek 
authors from that language, which constituted the 
main, indeed often the only, reason why Arabian 
writers were consulted. 

With the foundation of the medical school of 


Salerno in the tenth century, the modern history of 
medical education may be said to begin, for it had 
many of the features that distinguish our modern 
university medical schools. Its professors often 
came from a distance and had travelled extensively 
for purposes of study; they attracted patients of 
high rank from nearly every part of Europe, and 
these were generous in their patronage of the school. 
Students came from all over, from Africa and Asia, 
as well as Europe, and when abuses of medical prac 
tice began to creep in, a series of laws were made 
creating a standard of medical education and reg 
ulating the practice of medicine, that are interesting 
anticipations of modern movements of the same 
kind. Finally a law was passed requiring three years 
of preliminary work in logic and philosophy before 
medicine might be taken up, and then four years at 
medicine, with a subsequent year of practice with a 
physician before a license to practise for one s self 
was issued. In addition to this there was a still 
more surprising feature in the handing over of the 
department of women s diseases to women pro 
fessors, and the consequent opening up of licensure 
to practise medicine to a great many women in the 
southern part of Italy. The surprise that all this 
should have taken place in the south of Italy is 
lessened by recalling the fact that the lower end 
of the Italian peninsula had been early colonized by 
Greeks, that its name in later times was Magna 
Gragcia, and that the stimulus of Greek tradition 
has always been especially favorable to the develop 
ment of scientific medicine. 

Salerno s influence on Bologna is not difficult to 


trace, and the precious tradition of surgery par 
ticularly, which was carried to the northern uni 
versity, served to initiate a period of surgery last 
ing nearly two centuries, during which we have some 
of the greatest contributions to this branch of med 
ical science that were ever made. The development 
of the medical school at Bologna anticipated by but 
a short time that of a series of schools in the north 
Italian universities. Padua, Piacenza, Pisa, and 
Vicenza had medical schools in the later Middle 
Ages, the works of some of whose professors have 
attracted attention. It was from these north 
Italian medical schools that the tradition of close 
observation in medicine and of thoroughly scientific 
surgery found its way to Paris. Lanfranc was the 
carrier of surgery, and many French students who 
went to Italy came back with Italian methods. In 
the fourteenth century Guy de Chauliac made the 
grand tour in Italy, and then came back to write a 
text-book of surgery that is one of the monuments 
in this department of medical science. Before his 
time, Montpellier had attracted attention, but now it 
came to be looked upon as a recognized centre of 
great medical teaching. The absence of the Popes 
from Italy and the influence of their presence at 
Avignon made itself felt. While culture and edu 
cation declined in Italy in the midst of political dis 
turbances, they advanced materially at the south of 

For our generation undoubtedly the most interest 
ing chapter in the history of medieval medicine is 
that which tells of the marvellous development of 
surgery that took place in the thirteenth and four- 


teenth centuries. Considerable space has been de 
voted to this, because it represents not only 
an important phase of the history of medicine, 
and recalls the names and careers of great 
makers of medicine, but also because it il 
lustrates exquisitely the possibility of important 
discoveries in medicine being made, applied success 
fully for years, and then being lost or completely 
forgotten, though contained in important medical 
books that were always available for study. The 
more we know of this great period in the history of 
surgery, the more is the surprise at how much was 
accomplished, and how many details of our modern 
surgery were anticipated. Most of us have had 
some inkling of the fact that anaesthesia is not new, 
and that at various times in the world s history men 
have invented methods of producing states of sensi 
bility in which more or less painless operations were 
possible. Very few of us have realized, however, 
the perfection to which anaesthesia was developed, 
and the possibility this provided for the great 
surgeons of the later medieval centuries to do opera 
tions in all the great cavities of the body, the skull, 
the thorax, and the abdomen, quite as they are done 
in our own time and apparently with no little degree 
of success. 

Of course, any such extensive surgical interven 
tion even for serious affections would have been 
worse than useless under the septic conditions that 
would surely have prevailed if certain principles of 
antisepsis were not applied. Until comparatively 
recent years we have been quite confident in our as 
surance that antisepsis and asepsis were entirely 


modern developments of surgery. More knowledge, 
however, of the history of surgery has given a seri 
ous set-back to this self-complacency, and now we 
know that the later medieval surgeons understood 
practical antisepsis very well, and applied it success 
fully. They used strong wine as a dressing for 
their wounds, insisted on keeping them clean, and 
not allowing any extraneous material of any kind, 
ointments or the like, to be used on them. As a con 
sequence they were able to secure excellent results 
in the healing of wounds, and they were inclined to 
boast of the fact that their incisions healed by first 
intention and that, indeed, the scar left after them 
was scarcely noticeable. AYe know that wine would 
make a good antiseptic dressing, but until we actu 
ally read the reports of the results obtained by these 
old surgeons, we had no idea that it could be used to 
such excellent purpose. Antisepsis, like anaesthesia, 
was marvellously anticipated by the surgical fore 
fathers of the medieval period. 

It has always seemed to me that the story of 
Medieval Dentistry presented an even better il 
lustration of a great anticipatory development of 
surgery. This department represents only a small 
surgical specialty, but one which even at that period 
was given over to specialists, who were called denta- 
tores. Guy de Chauliac s review of the dentistry of 
his time and the state of the specialty, as pictured 
by John of Arcoli, is likely to be particularly inter 
esting, because if there is any department of med 
ical practice that we are sure is comparatively re 
cent in origin, it is dentistry. Here, however, we 
find that practically all our dental manipulations, 


the filling of teeth, artificial dentures, even ortho- 
dontia, were anticipated by the dentists of the Mid 
dle Ages. We have only the compressed account of 
it which is to be found in text-books of general 
surgery, and while in this they give mainly a her 
itage from the past, yet even this suffices to 
give us a picture very surprising in its detailed 
anticipation of much that we have been inclined 
to think of as quite modern in invention and dis 

Medicine developed much more slowly than 
surgery, or, rather, lagged behind it, as it seems 
nearly always prone to do. Surgical problems are 
simple, and their solution belongs to a great extent 
to a handicraft. That is, after all, what chirurgy, 
the old form of our word surgery, means. Medical 
problems are more complex and involve both art 
and science, so that solutions of them are often 
merely temporary and lack finality. During the 
Middle Ages, however, and especially towards the 
end of them, the most important branches of medi 
cine, diagnosis and therapeutics, took definite shape 
on the foundations that lie at the basis of our mod 
ern medical science. We hear of percussion for ab 
dominal conditions, and of the most careful study 
of the pulse and the respiration. There are charts 
for the varying color of the urine, and of the tints 
of the skin. With Nicholas of Cusa there came the 
definite suggestion of the need of exact methods of 
diagnosis. A mathematician himself, he wished to 
introduce mathematical methods into medical 
diagnosis, and suggested that the pulse should be 
counted in connection with the water clock, the 


water that passed being weighed, in order to get 
very definite comparative values for the pulse rate 
under varying conditions, and also that the specific 
gravity of fluids from the body should be ascer 
tained in order to get another definite datum in the 
knowledge of disease. It was long before these sug 
gestions were to bear much fruit, but it is interest 
ing to find them so clearly expressed. 

At the very end of the Middle Ages came the 
father of modern pharmaceutical chemistry, Basil 
Valentine. Already the spirit that was to mean so 
much for scientific investigation in the Renaissance 
period was abroad. Valentine, however, owes little 
to anything except his own investigations, and they 
were surprisingly successful, considering the cir 
cumstances of time and place. His practical sug 
gestions so far as drugs were concerned did not 
prove to have enduring value, but then this has been 
a fate shared by many of the masters of medicine. 
There were many phases of medical practice, how 
ever, that he insisted on in his works. He believed 
that the best agent for the cure of the disease was 
nature, and that the physician s main business must 
be to find out how nature worked, and then foster 
her efforts or endeavor to imitate them. He in 
sisted, also that personal observation, both of pa 
tients and drugs, was more important than book 
knowledge. Indeed, he has some rather strong ex 
pressions with regard to the utter valuelessness of 
book information in subjects where actual experi 
ence and observation are necessary. It gives a con 
ceit of knowledge quite unjustified by what is really 


What is interesting about all these men is that 
they faced the same problems in medicine that we 
have to, in much the same temper of mind that we 
do ourselves, and that, indeed, they succeeded in 
solving them almost as well as we have done, in spite 
of all that might be looked for from the accumula 
tion of knowledge ever since. 

It was very fortunate for the after time that in 
the period now known as the Renaissance, after the 
invention of printing, there were a number of seri 
ous, unselfish scholars who devoted themselves to 
the publication in fine printed editions of the works 
of these old-time makers of medicine. If the neglect 
of them that characterized the eighteenth and early 
nineteenth centuries had been the rule at the end 
of the fifteenth and during the sixteenth century, we 
would almost surely have been without the possibil 
ity of ever knowing that so many serious physicians 
lived and studied and wrote large important tomes 
during the Middle Ages. For our forefathers of a 
few generations ago had very little knowledge, and 
almost less interest, as to the Middle Ages, which 
they dismissed simply as the Dark Ages, quite sure 
that nothing worth while could possibly have come 
out of the Nazareth of that time. What they knew 
about the people who had lived during the thousand 
years before 1500 only seemed to them to prove the 
ignorance and the depths of superstition in which 
they were sunk. That medieval scholars should 
have written books not only well worth preservation, 
but containing anticipations of modern knowledge, 
and, though of course they could not have known 
that, even significant advances over their own sci- 


entific conditions, would have seemed to them quite 

Fortunately for us, then, the editions of the early 
printed books, so many of them monuments of learn 
ing and masterpieces of editorial work with regard 
to medieval masters of medicine, were lying in 
libraries waiting to be unearthed and restudied dur 
ing the nineteenth century. German and French 
scholars, especially during the last generation, have 
recovered the knowledge of this thousand years of 
human activity, and we know now and can sym 
pathetically study how the men of these times faced 
their problems, which were very much those of our 
own time, in almost precisely the same spirit as we 
do ours at the present time, and that their solutions 
of them are always interesting, often thorough and 
practical, and more frequently than we would like to 
think possible, resemble our own in many ways. 
For the possibility of this we are largely indebted 
originally to the scholars of the Renaissance. With 
out their work that of our investigators would have 
been quite unavailing. It is to be hoped, however, 
that our recovery of this period will not be followed 
by any further eclipse, though that seems to be 
almost the rule of human history, but that we shall 
continue to broaden our sympathetic knowledge of 
this wonderful medieval period, the study of which 
has had so many surprises in store for us. 




What we know of the life of the Founder of 
Christianity and how much He did for the ailing 
poor would make us expect that the religion that He 
established would foster the care and the cure of 
suffering humanity. As we have outlined in the In 
troduction, the first of the works of Christian service 
that was organized was the care of the sick. At first 
a portion of the bishop s house was given over to 
the shelter of the ailing, and a special order of as 
sistants to the clergy, the deaconesses, took care of 
them. As Christians became more numerous, spe 
cial hospitals were founded, and these became pub 
lic institutions just as soon as freedom from perse 
cution allowed the Christians the liberty to give 
overt expression to their feelings for the poor. 
"While hospitals of limited capacity for such special 
purposes as the sheltering of slaves or of soldiers 
and health establishments of various kinds for the 
wealthy had been erected before Christianity, this 
was the first time that anyone who was ill, no mat 
ter what the state of his pecuniary resources, could 
be sure to find shelter and care. The expression of 
the Emperor Julian the Apostate, that admission to 
these hospitals was not limited to Christians, is the 



best possible evidence of the liberal charity that in 
spired them. 

The ordinary passing student of the history of 
medicine or of hospital foundation and organization, 
can have no idea of the magnitude of some of these 
institutions, and their importance in the life of the 
time, unless it is especially pointed out. St. Basil, 
about the middle of the fourth century, erected what 
was spoken of as " a city for the sick," before the 
gates of Caesarea. Gregory of Nazianzen, his 
friend, says " that well built and furnished houses 
stood on both sides of streets symmetrically laid out 
about the church, and contained rooms for the sick, 
and the infirm of every variety were intrusted to 
the care of doctors and nurses." There were sep 
arate buildings for strangers, for the poor, and for 
the ailing, and comfortable dwellings for the physi 
cians and nurses. An important portion of the in 
stitution was set apart for the care of lepers, which 
constituted a prominent feature in Basil s work in 
which he himself took a special interest. Earlier in 
the same century Helena, the mother of the Em 
peror Constantine, had built similar institutions 
around Jerusalem, and during this same century 
nearly everywhere we have evidence of organi 
zation of hospitals and of care for the ailing 

Not only were hospitals erected, but arrangements 
were made for the care of the ailing poor in their 
own homes and for the visitation of them, and for 
the bringing to places adapted for their care and 
treatment of such as were found on the street, or 
neglected in their homes. The Church evidently 


considered itself bound to care for men s bodies as 
well as their souls, and many of the expressions in 
common use among Christians referred to this fact. 
Religion itself was spoken of as a medicine of the 
soul and the body. Christianity was denned as the 
religion of healing. The word salvation had a refer 
ence to both body and soul. Baptism was spoken 
of as the bath of the soul, the holy Eucharist as 
the elixir of immortal life, and penance as the medi 
cine of the soul. It is not surprising to find, then, 
that Harnack has found among the texts that il 
lustrate the history of early Christian literature this 
one: " In every community there shall be at least 
one widow appointed to assist women who are 
stricken with illness, and this widow shall be 
trained in her duties, neat and careful in her ways, 
shall not be self-seeking, must not indulge too freely 
in wine in order that she may be able to take up 
her duties at night as well as by day, and shall con 
sider it her duty to keep the Church officials in 
formed of all that seems necessary." 

The saving of deformed and ailing infants or 
children whose parents did not care to have the 
trouble of rearing them, required the establishment 
by the Christians of another set of institutions, 
Foundling Asylums and Hospitals for Children. 
Until the coming of Christianity parents were sup 
posed to have the right of life and death over their 
children, and no one questioned it. In every coun 
try in the world until the coming of Christianity this 
had always been the case. Besides, there were in 
stitutions for the care of the old. These are the 
classes of mankind who are especially liable to suf- 


fer from disease, and the opportunity to study 
human ailments in such institutions could scarcely 
help but provide facilities for clinical observa 
tion such as had not existed before. Unfor 
tunately the work of Christianity was hampered, 
first by the Koman persecutions, and then later by 
the invasion of the barbarians, who had to be edu 
cated and lifted up to a higher plane of civilization 
before they could be brought to appreciate the value 
of medical science, much less contribute to its de 

Harnack, whose writings in the higher criticism 
of Scripture have attracted so much attention in re 
cent years, began his career in the study of Christian 
antiquities with a monograph on Medical Features 
of Early Christianity. 1 He mentions altogether 
some sixteen physicians who reached distinc 
tion in the earliest days of Christianity. Some 
of these were priests, some of them bishops, 
as Theodotos of Laodicea; Eusebius, Bishop of 
Borne; Basilios, Bishop of Ancyra, and at least 
one, Hierakas, was the founder of a religious order. 
The first Christian physicians came mainly from 
Syria, as might be expected, for here the old Greek 
medical traditions were active. Among them must 
be enumerated Cosmas and Daniian, physicians who 
were martyred in the persecution of Diocletian, and 
who have been chosen as the patrons of the medical 
profession. Justinian erected a famous church to 
them. It became the scene of pilgrimages. Organi 
zations of various kinds since, as the College of St. 

" Medicinisches aus der Aeltesten Kirchen Geschichte," Leipzig, 


Come, and medical societies, have been named after 

Some idea of the interest of ecclesiastics in med 
ical affairs may be gathered from a letter of Bishop 
Theodore! of Cyrus, directed to the prefect of the 
city, when he was about to leave the place. He wrote 
(see Puschmann, Vol. I., p. 494): "When I took 
up the Bishopric of Cyrus I made every effort to 
bring in from all sides the arts that would be useful 
to the people. I succeeded in persuading skilled 
physicians to take up their residence here. Among 
these is a very pious priest, Peter, who practises 
medicine with great skill, and is well known for his 
care for the people. Now that I am about to leave 
the city, some of those who came at my invitation 
are preparing also to go. Peter seems resolved to 
do this. I appeal to your highness, therefore, in 
order to commend him to your special care. He 
handles patients with great skill and brings about 
many cures." 

Distinguished Christian writers and scholars, and 
the Fathers of the Church in the early centuries, evi 
dently paid much attention to medicine. Tertullian 
speaks of medical science as the sister of philosophy, 
and has many references to the medical doctrines 
discussed in his time. Lactantius, in his work, " De 
Opificio Dei," has much to say with regard to the 
human body as representing the necessity for design 
in creation. His teleological arguments have much 
more force now than they would have had for peo 
ple generally twenty years ago. We have come back 
to recognize the place of teleology. Clement of 
Alexandria was an early Christian temperance ad- 


vocate, who argued that the use of wine was only 
justified when it did good as a medicine. The prob 
lems of embryology and of diseases of childhood 
interested him as they did many other of the early 
Christian writers. 


The first great Christian physician whose works 
meant much for his own time, and whose writings 
have become a classic in medicine, was Ae tius Arni- 
denus, that is, Ae tius of Amida, who was born in the 
town of that name in Mesopotamia, on the upper 
Tigris (now Diarbekir), and who flourished about 
the middle of the sixth century. His medical studies, 
as he has told us himself, were made at Alexandria. 
After having attracted attention by his medical 
learning and skill, he became physician to one of 
the emperors at Byzantium, very probably Justinian, 
(527-565). He seems to have been succeeded in the 
special post that was created for him at court by 
Alexander of Tralles, the second of the great Chris 
tian physicians. There is no doubt that Ae tius was 
a Christian, for he mentions Christian mysteries, 
and appeals to the name of the Saviour and the 
martyrs. He was evidently a man of wide reading, 
for he quotes from practically every important med 
ical writer before his time. Indeed, he is most 
valuable for the history of medicine, because he gives 
us some idea of the mode of treatment of various 
subjects by predecessors whose fame we know, but 
none of whose works have come to us. His official 
career and the patronage of the Emperor, the 


breadth of his scholarship, and the thoroughly prac 
tical character of his teaching, show how medical 
science and medical art were being developed and 
encouraged at this time. 

Aetius work that is preserved for us is known in 
medical literature as his sixteen books on medical 
practice. In most of the manuscript it is divided 
into four Tetrabibloi, or four book parts, each of 
which consists of four sections called Logoi in 
Greek, Sermones in Latin. This work embraces all 
the departments of medicine, and has a considerable 
portion devoted to surgery, but most of the im 
portant operations and the chapters on fractures 
and dislocations are lacking. Aetius himself an 
nounces that he had prepared a special work on 
surgery, but this is lost. Doubtless the important 
chapters that we have noted as lacking in his work 
would be found in this. He is much richer in 
pathology than most of the older writers, at least 
of the Christian era ; for instance, Gurlt says that he 
treats this feature of the subject much more ex 
tensively even than Paulus ./Eginetus, but most of 
his work is devoted to therapeutics. 

At times those who read these old books from cer 
tain modern standpoints are surprised to find such 
noteworthy differences between writers on medicine, 
who are separated sometimes only by a generation, 
and sometimes by not more than a century, in what 
regards the comparative amount of space given to 
pathology, etiology, and therapeutics. Just exactly 
the same differences exist in our own day, however. 
We all know that for those who want pathology and 
etiology the work of one of our great teachers is to 


be consulted, while for therapeutics it is better to 
go to someone else. When we find such differences 
among the men of the olden time we are not so 
apt to look at them with sympathetic discrimina 
tion, as we do with regard to our contemporaries. 
We may even set them down to ignorance rather 
than specialization of interest. These differences 
depend on the attitude of mind of the physician, and 
are largely the result of his own personal equation. 
They do not reflect in any way either on his judg 
ment or on the special knowledge of his time, but 
are the index of his special receptivity and teaching 

Aetius first and second books are taken up en 
tirely with drugs. The first book contains a list of 
drugs arranged according to the Greek alphabet. In 
the third book other remedial measures, dietetic, 
manipulative, and even operative, are suggested. 
In these are included venesection, the opening of an 
artery, cupping, leeches, and the like. The fourth 
and fifth books take up hygiene, special dietetics, and 
general pathology. In the sixth book what the 
Germans call special pathology and therapy begins 
with the diseases of the head. The first chapter 
treats of hydrocephalus. In this same book rabies 
is treated. What Aetius has consists mainly of 
quotations from previous authors, many of whom he 
had evidently read with great care. 

Concerning those bitten by a rabid dog or those 
who fear water," Gurlt has quoted the following ex 
pression, with regard to which most people will be 
quite ready to agree with him when he says that it 
contains a great deal of truth, usually thought to be 


of much later origin : When, therefore, any one 
has been bitten by a rabid dog the treatment of the 
wound must be undertaken just as soon as possible, 
even though the bite should be small and only super 
ficial. One thing is certain, that none of those who 
are not rightly treated escape the fatal effect. The 
first thing to do is to make the wound larger, the 
mouth of it being divided and dilated by the scalpel. 
Then every portion of it and the surrounding tissues 
must be firmly pressed upon with the definite pur 
pose of causing a large efflux of blood from the part. 
Then the wound should be deeply cauterized, etc." 

There are special chapters devoted to eye and ear 
diseases, and to various affections of the face. Un 
der this the question of tattooing and its removal 
comes in. It is surprising how much Aetius has 
with regard to such nasal affections as polyps and 
ulcers and bleedings from the nose. In this book, 
however, he treats only of their medicinal treatment. 
What he has to say about affections of the teeth is 
so interesting that it deserves a paragraph or two 
by itself. 

He had much to say with regard to the nervous 
supply of the mucous membranes of the gums, 
tongue, and mouth, and taught that the teeth re 
ceived nerves through the small hole existing at the 
end of every root. For children cutting teeth he 
advised the chewing of hard objects, and thought 
that the chewing of rather hard materials was good 
also for the teeth of adults. For fistulas leading 
to the roots of teeth he suggests various irritant 
treatments, and, if they do not succeed, recommends 
the removal of the teeth. He seems to have known 


much about affections of the gums and recognizes a 
benignant and malignant epulis. He thought that 
one form of epulis was due to inflammation of a 
chronic character, and suggests that if remedies do 
not succeed it should be removed. His work is of 
interest mainly as showing that even at this time, 
when the desire for information of this kind is usu 
ally supposed to have been in abeyance, physicians 
were gathering information about all sorts even of 
the minor ailments of mankind, gathering what had 
been written about them, commenting on it, adding 
their own observations, and in general trying to 
solve the problems as well as they could. 

Aetius seems to have had a pretty good idea of 
diphtheria. He speaks of it in connection with 
other throat manifestations under the heading of 
" crusty and pestilent ulcers of the tonsils." He 
divides the anginas generally into four kinds. The 
first consists of inflammation of the fauces with the 
classic symptoms, the second presents no inflamma 
tion of the mouth nor of the fauces, but is compli 
cated by a sense of suffocation apparently our 
croup. The third consists of external and internal 
inflammation of the mouth and throat, extending 
towards the chin. The fourth is an affection rather 
of the neck, due to an inflammation of the vertebrae 
retropharyngeal abscess that may be followed 
by luxation and is complicated by great difficulty of 
respiration. All of these have as a common symp 
tom difficulty of swallowing. This is greater in one 
variety than in another at different times. In cer 
tain affections even " drinks when taken are re 
turned through the nose." 


Hypertrophy of the tonsils Aetius speaks of 
them as glands is to be treated by various 
astringent remedies, but if these fail the structures 
should be excised. His description of the excision 
is rather clear and detailed. The patient should be 
put in a good full light, and the mouth should be 
held open and each gland pulled forward by a hook 
and excised. The operator should be careful, how 
ever, only to excise those portions that are beyond 
the natural size, for if any of the natural substance 
of the gland is cut into, or if the incision is made 
beyond the projecting portion of the tonsil, there is 
grave danger of serious hemorrhage. After ex 
cision a mixture of water and vinegar should be kept 
in the mouth for some time. This should be admin 
istered cold in order to prevent the flow of blood. 
After this very cold water should be taken. 

In this same book, Chapter L, he treats of for 
eign bodies in the respiratory and upper digestive 
tracts. If there is anything in the larynx or the 
bronchial tubes the attempt must be made to secure 
its ejection by the production of coughing or sneez 
ing. If the foreign body can be seen it should be 
grasped with a pincers and removed. If it is in 
the esophagus, Aetius suggests that the patient 
should be made to swallow a sponge dipped in 
grease, or a piece of fat meat, to either of which a 
string has been attached, in order that the foreign 
body may be caught and drawn out. If it seems 
preferable to carry the body on into the stomach, 
the swallowing of large rnouthfuls of fresh bread 
or other such material is recommended. 

With regard to goitre, Aetius has some interest- 


ing details. He says that " all tumors occurring 
in the throat region are called bronchoceles, for 
every tumor among the ancients was called a cele, 
and, though the name is common to them, they differ 
very much from one another." Some of them are 
fatty, some of them are pultaceous, some of them 
are cancerous, and some of them he calls honey 
tumors, because of a honey-like humor they contain. 
" Sometimes they are due to a local dilatation of the 
blood vessels, and this is most frequently connected 
with parturition, apparently being due to the draw 
ing of the breath being prevented or repressed dur 
ing the most violent pains of the patient. Such 
local dilatation at this point of the veins is incurable, 
but there are also hard tumors like scirrhus and 
malignant tumors, and those of great size. With 
the exception of these last, all the tumors of this 
region are easily cured, yielding either to surgery 
or to remedies. Surgery must be adapted to the 
special tumor, whether it be honey-like or fatty, or 
pultaceous." The prognosis of goitrous tumors is 
much better than might be expected, but evidently 
Ae tius saw a number of the functional disturbances 
and enlargements of the thyroid gland, which are 
so variable in character as apparently to be quite 
amenable to treatment. 

Ae tius treatment of the subject of varicosities 
is quite complete in its suggestions. " The term 
varices," he says, " is applied to dilated veins, 
which occur sometimes in connection with the testes 
and sometimes in the limbs. Operations on 
testicular varices patients do not readily consent to ; 
those on the limbs may be cured in several ways. 


First, simple section of the skin lying above the 
dilated vessel is made, and with the hook it is sep 
arated from the neighboring tissues and tied. After 
this the dilated portion is removed and pressure 
applied by means of a bandage. The patient is 
ordered to remain quiet, but with the legs higher 
than the head. Some people prefer treatment by 
means of the cautery." Gurlt, in his " History of 
Surgery, calls attention to the fact that two of our 
modern methods of treating varicose veins are thus 
discussed in Aetius, that by ligation and that by 
the cautery. The cautery was applied over a space 
the breadth of a finger at several points along the 
dilated veins. 

Aetius chapters on obstetrics and gynaecology 
are of special interest, because, while we are prone 
to think that gynaecology particularly is a compara 
tively modern development of surgery, this surgical 
authority of the early Middle Ages treats it rather 
exhaustively. His sixteenth book is for the most 
part (one hundred and eleven chapters of it) de 
voted to these two subjects. He has a number of 
interesting details in the first thirty-six chapters 
with regard to conception, pregnancy, labor, and 
lactation, which show how practical were the views 
of the physicians of the time. Gurlt has given us 
some details of his chapters on diseases of the 
breast. Aetius differentiates phagedenic and rodent 
ulcers and cancer. All the ordinary forms of 
phagedenic ulcer yield to treatment, while malignant 
growths are rendered worse by them. Where ulcers 
are old, he suggests the removal of their thickened 
edges by the cautery, for this hastens cure and 


prevents hemorrhage. With regard to cancer, he 
quotes from Archigenes and Leonides. He says 
that these tumors are very frequent in women, and 
quite rare in men. Even at this time cancer had 
been observed and recognized in the male breast. 
He emphasizes the fact that cancerous nodules be 
come prominent and become attached to surround 
ing tissues. There are two forms, those with ulcer, 
and those without. He describes the enlargement 
of the veins that follows, the actual varicosities, and 
the dusky or livid redness of the parts which seem 
to be soft, but are really very hard. He says 
that they are often complicated by very painful con 
ditions, and that they cause enlargement of the 
glands and of the arms. The pain may spread to 
the clavicle and the scapula, and he seems to think 
that it is the pain that causes the enlargement of 
the glands at a distance. 

His description of ulcerative cancer of the breast 
is very striking. He says that it erodes without 
cause, penetrating ever deeper and deeper, and can 
not be stopped until it emits a secretion worse than 
the poison of wild beasts, copious and abominable 
to the smell. "With these other symptoms pains are 
present. This form of cancer is especially made 
worse by drugs and by all manner of manipulation. 
The paragraph from Leonides quoted by Aetius 
gives a description of operation for cancer of the 
breast, in which he insists particularly on the ex 
tensive removal of tissue and the free use of the 
cautery. " The cautery is used at first in order to 
prevent bleeding, but also because it helps to destroy 
the remains of diseased tissues. When the burning 


is deep, prognosis is much better. Even in cases 
where indurated tumors of the breast occur that 
might be removed without danger of bleeding, it is 
better to use the cautery freely, though the amputa 
tion of such a portion down to the healthy parts may 
suffice." Aetius quotes this with approval. 

Others before Aetius had suggested the connec 
tion between hypertrophy of the clitoris and cer 
tain exaggerated manifestations of the sexual in 
stinct, and the development of vicious sexual habits. 
As might be expected from this first great Christian 
physician and surgeon, he emphasizes this etiology 
for certain cases, and outlines an operation for it. 
This operation had been suggested before, but Aetius 
goes into it in detail and describes just how the 
operation should be done, so as to secure complete 
amputation of the enlarged organ, yet without in 
jury. He warns of the danger of removing more 
than just the structure itself, because this may give 
rise to ugly and bothersome scars. After the opera 
tion a sponge wet with astringent wine should be ap 
plied, or cold water, especially if there is much 
tendency to bleeding, and afterwards a sponge with 
manna or frankincense scattered over it should be 
bound on. He treats of other pathological condi 
tions of the female genitalia, varicose veins, growths 
of various kinds, hypertrophy of the portio vaginalis 
uteri, an operation for which is described, and of 
various tumors. He describes epithelioma very 
clearly, enumerates its most frequent locations in 
their order, lays down its bad prognosis, and hence 
the necessity for early operation with entire re 
moval of the new growth whenever possible. He 


feared hemorrhage very much, however, and warns 
with regard to it, and evidently had had some very 
unfortunate experiences in the treatment of these 

Aetius seems to have had as thoroughly scientific 
an interest in certain phases of chemistry apart 
from medicine as any educated physician of the 
modern time might have. Mr. A. P. Laurie, in his 
" Materials of the Printer s Craft," * calls attention 
to the fact that the earliest reference to the use of 
drying oil for varnish is made by the physician 

Aetius, or Aetios, to use for the nonce the Greek 
spelling of his name, which sometimes occurs in 
medical literature, and should be known, has been 
the subject of very varied estimation at different 
times. About the time of the Renaissance he was 
one of the first of the early writers on medicine ac 
corded the honor of printing, and then was reprinted 
many times, so that his estimation was very high. 
With the reawakening of clinical medicine in the 
seventeenth century his reputation waxed again, and 
Boerhaave declared that the works of Aetius had 
as much importance for physicians as had the Pan 
dects of Justinian for lawyers. This high estima 
tion had survived almost from the time of the 
Eenaissance, when Cornelius went so far as to say: 
" Believe me, that whoever is deeply desirous of 
studying things medical, if he would have the whole 
of Galen abbreviated and the whole of Oribasius ex 
tended, and the whole of Paulus (of JEgina) ampli 
fied, if he would have all the special remedies of the 

1 Foulis, London and Edinburgh, 1910. 


old physicians as well in pharmacy as in surgery 
boiled down to a summa for all affections, he will 
find it in Ae tius." Naturally enough, this exag 
gerated estimation was followed by a reaction, in 
which Ae tius came to be valued at much less than he 
deserved. After all is taken into account in the 
vicissitudes of his fame, it is clear, however, that he 
is one of the most important links in the chain of 
medical tradition, and himself worthy to be classed 
among makers of medicine for his personal observa 
tions and efforts to pass on the teachings of the old 
to succeeding generations. 


An even more striking example than the life and 
work of Ae tius as evidence for the encouragement 
and patronage of medicine in early Christian times, 
is to be found in the career of Alexander of Tralles, 
whose writings have been the subject of most care 
ful attention in the Renaissance period and in our 
own, and who must be considered one of the great 
independent thinkers in medicine. While it is usu 
ally assumed that whatever there was of medical 
writing during the Middle Ages was mere copying 
and compilation, here at least is a man who could 
not only judiciously select, but who could critically 
estimate the value of medical opinions and pro 
cedure, and weighing them by his own experience 
and observation, turn out work that was valuable 
for all succeeding generations. The modern Ger 
man school of medical historians have agreed in 
declaring him an independent thinker and physician, 


who represents a distinct link in medical tradition. 

He came of a distinguished family, in which the 
following of medicine as a profession might be 
looked upon as hereditary. His father was a physi 
cian, and it is probable that there were physicians 
in preceding generations, and one of his brothers, 
Dioscoros, was also a successful physician. Alto 
gether four of his brothers reached such distinction 
in their life work that their names have come down 
to us through nearly fifteen hundred years. The 
eldest of them was Anthemios, the builder of the 
great church of Santa Sophia in Constantinople. 
As this is one of the world s great churches, and 
still stands for the admiration of men a millennium 
and a half after its completion, it is easy to under 
stand that Anthemios reputation is well founded. 
A second brother was Metrodoros, a distinguished 
grammarian and teacher, especially of the youthful 
nobility of Byzantium, as it was then called, or Con 
stantinople, as we have come to call it. A third 
brother was a prominent jurist, also in Constan 
tinople. The fourth brother, Dioscoros, like Alex 
ander, a physician, remained in his birthplace, 
Tralles, and acquired there a great practice. 

It was with his father at Tralles that Alexander 
received his early medical training. The father of 
a friend and colleague, Cosmas, who later dedicated 
a book to Alexander, was also his teacher, while he 
was in his native city. As a young man, Alexander 
undertook extensive travels, which led him into 
Italy, Gaul, Spain, and Africa, everywhere gather 
ing medical knowledge and medical experience. 
Then he settled down at Konie, probably in an official 


position, and practised medicine successfully until 
a very old age. He was probably eighty years of 
age when, some time during the first decade of the 
seventh century, he died. 

Puschmann, who has made a special study of 
Alexander s life and work, suggests that since some 
of his books have the form of academic lectures he 
was probably a teacher of medicine at Rome. As 
might be expected from what we know of the rela 
tions of the rest of the family to the nobility of the 
time, it is easy to understand, especially in connec 
tion with hints in Alexander s favorite modes of 
therapeutics, that costliness of remedies made no 
difference to his patients, that he must have had the 
treatment of some of the wealthiest families in 

His principal work is a Treatise on the Pathology 
and Therapeutics of Internal Diseases, in twelve 
books. The first eleven books were evidently 
material gathered for lectures or teaching of some 
kind. The twelfth book, in which considerable use 
of Aetms writings is made, was written, according 
to Puschmann, toward the end of Alexander s life, 
and was meant to contain supplementary matter, 
comprising especially his views gathered from ob 
servation as to the pathology of internal diseases. 
A shorter treatise of Alexander is with regard to 
intestinal parasites. There are many printed edi 
tions of these books, and many manuscript copies 
are in existence. Alexander was often quoted dur 
ing the Middle Ages, and in recent years, with the 
growth of our knowledge of medical history, he has 
come to be a favorite subject of study. 


Alexander s first book of pathology and thera 
peutics treats of head and brain diseases. For bald 
ness, the first symptom of which is falling out of 
the hair, he counsels cutting the hair short, washing 
the scalp vigorously, and the rubbing in of sulphur 
ointments. For grey hair he suggests certain hair 
dyes, as nutgalls, red wine, and so forth. For 
dandruff, which he described as the excessive forma 
tion of small flake-like scales, he recommends rub 
bing with wine, with certain salves, and washing with 
salt water. 

He gives a good deal of attention to diseases of 
the nervous system. He has a rather interesting 
chapter on headache. The affection occurs in con 
nection with fevers, after excess in drinking, and as 
a consequence of injury to the skull. Besides, it 
develops as a result of disturbances of the natural 
processes in the head, the stomach, the liver, and 
the spleen. Headache, as the first symptom of in 
flammation of the brain, is often the forerunner of 
convulsions, delirium, and sudden death. Chronic 
or recurrent headache occurs in connection with 
plethora, diseases of the brain, biliousness, digestive 
disturbances, insomnia, and continued worry. 
Hemicrania has its origin in the brain, because of 
the presence of toxic materials, and specially their 
transformation into gaseous substances. It also 
occurs in connection with abdominal affections. This 
latter remark particularly is directed to the cases 
which occur in women. 

For apoplexy and the consequent paralysis, Alex 
ander considered venesection the best remedy. 
Massage, rubbings, baths, and warm applications 


are recommended for the paralytic conditions. He 
had evidently had considerable experience with 
epilepsy. It develops either from injuries of the 
head or from disturbances of the stomach, or oc 
casionally other parts of the body. When it occurs 
in nursing infants, nourishment is the best remedy, 
and he gives detailed directions for the selection of 
a wet nurse, and very careful directions as to her 
mode of life. He emphasizes very much the neces 
sity for careful attention to the gastro-intestmal 
tract in many cases of epilepsy. Planned diet and 
regular bowels are very helpful. He rejects treat 
ment of the condition by surgery of the head, either 
by trephining or by incisions, or cauterization. Reg 
ular exercise, baths, sexual abstinence are the 
foundation of any successful treatment. It is prob 
able that we have returned to Alexander s treat 
ment of epilepsy much more nearly than is generally 
thought. There are those who still think that rem 
edies of various kinds do good, but in the large 
epileptic colonies regular exercise, bland diet, reg 
ulation of the bowels, and avoidance of excesses of 
all kinds, with occupation of mind, constitute the 
mainstay of their treatment. 

Alexander has much to say with regard to phre- 
nitis, a febrile condition complicated by delirium, 
which, following Galen, he considers an affection of 
the brain. It is evidently the brain fever of the 
generations preceding the last, an important element 
of which was made up of the infectious meningitises. 
Alexander suggests its treatment by opiates after 
preliminary venesection, rubbings, lukewarm baths, 
and stimulating drinks. Every disturbance of the 


patient must be avoided, and visitors must be for 
bidden. The patient s room should rather be light 
than dark. His teaching crops up constantly in the 
centuries after his time, until the end of the nine 
teenth century, and while we now understand the 
causes of the condition better, we can do little more 
for it than he did. 

Alexander divided mental diseases into two, the 
maniacal and melancholic. Mania was, however, 
really a further development of melancholia, and 
represented a high grade of insanity. Under melan 
choly he groups not only what we denominate by 
that term, but also all depressed conditions, and 
the paranoias, as also many cases of imbecility. 
The cause of mental diseases was to be found in the 
blood. He counselled the use of venesection, of lax 
atives and purgatives, of baths and stimulant rem 
edies. He insisted very much, however, on mental 
influence in the disease, on change of place and air, 
visits to the theatre, and every possible form of 
mental diversion, as among the best remedial 

After his book on diseases of the head, his most 
important section is on diseases of the respiratory 
system. In this he treats first of angina, and recom 
mends as gargles at the beginning light astringents ; 
later stronger astringents, as aluni and soda dis 
solved in warm water, should be employed. Warm 
compresses, venesection from the sublingual veins, 
and from the jugular, and purgatives in severe 
cases, are the further remedies. He treats of cough 
as a symptom due to hot or cold, dry or wet dys- 
crasias. Opium preparations carefully used are the 


best remedies. The breathing in of steam impreg 
nated with various ethereal resins, was also recom 

He gives a rather interestingly modern treatment 
of consumption. He recommends an abundance of 
milk with a strong nutritious diet, as digestible as 
possible. A good auxiliary to this treatment was 
change of air, a sea voyage, and a stay at a water 
ing-place. Asses and mares milk are much better 
for these patients than cows and goats milk. There 
is not enough difference in the composition of these 
various milks to make their special consumption of 
import, but it is probable that the suggestive in 
fluence of the taking of an unusual milk had a very 
favorable effect upon patients, and this effect was 
renewed frequently, so that much good was 
ultimately accomplished. For hemoptysis, espe 
cially when it was acute and due as Alexander 
thought to the rupture of a blood vessel in the lungs, 
he recommended the opening of a vein at the elbow 
or the ankle in order to divert the blood from the 
place of rupture to the healthy parts of the circula 
tion. He insisted that the patients must rest, that 
they should take acid and astringent drinks, that 
cold compresses should be placed upon the chest 
(our ice bags), and that they should take only a 
liquid diet at most lukewarm, or, better, if agree 
able to them, cold. When the bleeding stopped, a 
milk cure was very useful for the restoration of 
these patients to strength. 

It is not surprising, then, to find that Alexander 
suggests a thoroughly rational treatment for 
pleurisy. He recognizes this as an inflammation 


of the membrane covering the ribs, and its symp 
toms are severe pain, disturbance of breathing, and 
coughing. In certain cases there is severe fever, 
and Alexander knows of purulent pleurisy, and the 
fact that when pus is present the side on which it 
is is warmer than the other. Pleurisy can be, he 
says, rather easily confounded with certain liver 
affections, but there is a peculiar hardness of the 
pulse characteristic of pleurisy, and there is no ex 
pectoration in liver cases, though it also may be ab 
sent in many cases of pleurisy. Sufferers from 
liver disease usually have a paler color than 
pleuritics. His treatment consists in venesection, 
purgatives, and, when pus is formed, local incision. 
He recommends the laying on of sponges dipped 
in warm water, and the internal use of honey lem 
onade. Opium should not be used unless the patient 
suffers from sleeplessness. 

Some of the general principles of therapeutics 
that Alexander lays down are very interesting, even 
from our modern standpoint. Trust should not be 
placed in any single method of treatment. Every 
available means of bringing relief to the patient 
should be tried. " The duty of the physician is to 
cool what is hot, to warm, what is cold, to dry what 
is moist, and to moisten what is dry. He should 
look upon the patient as a besieged city, and try to 
rescue him with every means that art and science 
places at his command. The physician should be an 
inventor, and think out new ways and means by 
which the cure of the patient s affection and the 
relief of his symptoms may be brought about." The 
most important factor in his therapeutics is diet. 


Watering-places and various forms of mineral 
waters, as well as warm baths and sea baths, are 
constantly recommended by him. He took strong 
ground against the use of many drugs, and the rage 
for operating. The prophylaxis of disease is in 
Alexander s opinion the important part of the 
physician s duty. His treatment of fever shows the 
application of his principle: cold baths, cold com 
presses, and a cooling diet, were his favorite rem 
edies. He encouraged diaphoresis nearly always, 
and gave wine and stimulating drugs only when the 
patient was very weak. He differentiates two kinds 
of quartan fever. One of these he attributes to an 
affection of the spleen, because he had noticed that 
the spleen was enlarged during it, and that, after 
purgation, the enlarged spleen decreased in size. 

Alexander was a strong opponent of drastic rem 
edies of all kinds. He did not believe in strong 
purgatives, nor in profuse and sudden blood-let 
tings. He opposed arteriotomy for this reason, and 
refused to employ extensive cauterization. His 
diagnosis is thorough and careful. He insisted par 
ticularly on inspection and palpation of the whole 
body; on careful examination of the urine, of the 
feces, and the sputum; on study of the pulse and 
the breathing. He thought that a great deal might 
be learned from the patient s history. The general 
constitution is also of importance. His therapeutics 
is, above all, individual. Remedies must be admin 
istered with careful reference to the constitution, 
the age, the sex, and the condition of the patient s 
strength. Special attention must always be paid 
to nature s efforts to cure, and these must be en- 


couraged as far as possible. Alexander had no 
sympathy at all with the idea that remedies must 
work against nature. His position in this matter 
places him among the dozen men whose name and 
writings have given them an enduring place in the 
favor of the profession at all times, when we were 
not being carried away by some therapeutic fad or 
imagining that some new theory solved the whole 
problem of the causation and cure of disease. 

Gurlt, in his " History of Surgery," has ab 
stracted from Alexander particularly certain phases 
of what the Germans call external pathology and 
therapeutics. For instance, Alexander s treatment 
of troubles connected with the ear is very interest 
ing. Gurlt declares that this chapter alone provides 
striking evidence for Alexander s practical experi 
ence and power of observation, as well as for his 
knowledge of the literature of medicine. He con 
siders that only a short abstract is needed to show 

For water that has found its way into the external 
ear, Alexander suggests a mode of treatment that is 
still popularly used. The patient should stand upon 
the leg corresponding to the side on which there is 
water in his ear, and then, with head leaning to that 
side, should hop or kick out with the other leg. The 
water may be drawn out by means of suction 
through a reed. In order to get foreign bodies out 
of the external auditory canal, an ear spoon or other 
small instrument should be wrapped in wool and 
dipped in turpentine, or some other sticky material. 
Occasionally he has seen sneezing, especially if the 
mouth and nose are covered with a cloth, and the 


head leant toward the affected side, bring about a 
dislodgment of the foreign body. If these means do 
not succeed, gentle injections of warm oil or wash 
ing out of the canal with honey water should be 
tried. Foreign bodies may also be removed by 
means of suction. Insects or worms that find their 
way into the ear may be killed by injections of acid 
and oil, or other substances. 

Gurlt also calls attention to Alexander s careful 
differentiation of certain very dangerous forms of 
inflammation of the throat from others which are 
rather readily treated. He says, " Inflammation of 
the throat may, under certain circumstances, belong 
to the severest diseases. The patients succumb to 
it as a consequence of suffocation, just as if they 
were choked or hanged. For this reason, perhaps, 
the affection bears the name synanche, which means 
constriction." He then points out various other 
forms of inflammation of the throat, acute and 
chronic, suggesting various names and the differ 
ential diagnostic signs. 

One of the most surprising chapters of Alexan 
der s knowledge of pathology and therapeutics is 
to be found in his treatment of the subject of in 
testinal worms, which is contained in a letter sent 
by him to his friend, Theodore, whose child was suf 
fering from them. He describes the oxyuris ver- 
micularis with knowledge manifestly derived from 
personal observation. He dwells on the itching in 
the region of the anus, caused by the oxyuris, and 
the fact that they probably find their way into the 
upper part of the digestive tract because of the 
soiling of the hands. He knew that the tapeworms 


often reached great length, he has seen one over 
sixteen feet long, and also that they had a life cycle, 
so that they existed in two different forms. He de 
scribes the roundworrns as existing in the intestines, 
but occasionally wandering into the stomach to be 
vomited. His vermifuges were the flowers and the 
seeds of the pomegranate, the seeds of the helio 
trope, castor-oil, and certain herbs that are still 
used, by country people, at least, as worm medicines. 
For roundworms he recommended especially a de 
coction of artemisia maritima, coriander seeds, and 
decoctions of thyme. Our return to thymol for in 
testinal parasites is interesting. For the oxyuris 
he prescribed clysters of ethereal oils. We have 
not advanced much in our treatment of intestinal 
worms in the fifteen hundred years since Alexan 
der s time. 


Another extremely important writer in these early 
medieval times, whose opportunities for study in 
medicine and for the practice of it, were afforded 
him by Christian schools and Christian hospitals, 
was Paul of ^Egina. He was born on the island of 
^Egina, hence the name ^Eginetus, by which he is 
commonly known. There used to be considerable 
doubt as to just when Paul lived, and dates for his 
career were placed as widely apart as the fifth and 
the seventh centuries. We know that he was edu 
cated at the University of Alexandria. As that in 
stitution was broken up at the time of the capture 
of the city by the Arabs, he cannot have been there 


later than during the first half of the seventh cen 
tury. An Arabian writer, Abul Farag, in " The 
Story of the Reign of the Emperor Heraclius," who 
died 641, says that " among the celebrated physi 
cians who flourished at this tune was Paulas 
^Eginetus." In his works Paul quotes from Alex 
ander of Tralles, so that there seems to be no doubt 
now that his life must be placed in the seventh 

The most important portion of Paul s work for 
the modern time is contained in his sixth book on 
surgery. In this his personal observations are 
especially accumulated. Gurlt has reviewed it at 
considerable length, devoting altogether nearly 
thirty pages to it, and it well deserves this lengthy 
abstract. Paul quotes a great many of the writers 
on surgery before his time, and then adds the re 
sults of his own observation and experience. In 
it one finds careful detailed descriptions of many 
operations that are usually supposed to be modern. 
Very probably the description quoted by Gurlt of 
the method of treating fishbones that have become 
caught in the throat will give the best idea of how 
thoroughly practical Paul is in his directions. He 
says : " It will often happen in eating that fish 
bones or other objects may be swallowed and get 
caught in some part of the throat. If they can be 
seen they should be removed with the forceps de 
signed for that purpose. Where they are deeper, 
some recommend that the patient should swallow 
large mouthfuls of bread or other such food. Others 
recommend that a clean soft sponge of small circum 
ference to which a string is attached be swallowed, 


and then drawn out by means of the string. This 
should be repeated until the bone or other object 
gets caught in the sponge and is drawn out. If the 
patient is seen immediately after eating, and the 
swallowed object is not visible, vomiting should be 
brought on by means of a finger in the throat or 
irritation with the feather, and then not infrequently 
the swallowed object will be brought up with the 

In the chapter immediately following this, 
XXXIII, there is a description of the method of 
opening the larynx or the trachea, with the indica 
tions for this operation. The surgeon will know 
that he has opened the trachea when the air streams 
out of the wound with some force, and the voice is 
lost. As soon as the danger of suffocation is over, 
the edges of the wound should be freshened and the 
skin surfaces brought together with sutures. Only 
the skin without the cartilage should be sutured, 
and general treatment for encouraging union should 
be employed. If the wound fails to heal immedi 
ately, a treatment calculated to encourage granula 
tions should be undertaken. This same method of 
treatment will be of service whenever we happen to 
have a patient who, in order to commit suicide, has 
cut his throat. Paul s exact term is, perhaps, best 
translated by the expression, slashed his larynx. 

One of the features of Paul s " Treatise on Sur 
gery is his description of a radical operation for 
hernia. He describes scrotal hernia under the name 
enterocele, and says that it is due either to a tearing 
or a stretching of the peritoneum. It may be the 
consequence either of injury or of violent efforts 


made during crying. When the scrotum contains 
only omentum, he calls the condition epiplocele; 
when it also contains intestine, an epiplo-enterocele. 
Hernia that does not descend into the scrotum he 
calls bubonocele. For operation the patient should 
be placed on the back, and, the skin of the inguinal 
region being stretched by an assistant, an oblique 
incision in the direction in which the blood vessels 
run should be made. The incision should then be 
stretched by means of retractors, until the contents 
of the sac can be lifted out. All adhesions should 
be broken up and the fat be removed, and the hernia 
replaced within the abdomen. Care should be taken 
that no loop of intestine is allowed to remain. Then 
a large needle with double thread made of ten 
strands should be run through the middle of the in 
cision in the end of the peritoneum, and tied firmly 
in cross sutures. The outer structures should be 
brought together with a second ligature, and the 
lower end of the incision should have a wick placed in 
it for drainage, and the site of operation should be 
covered with an oil bandage. 

The Arab writer, Abnl Farag, to whose references 
we owe the definite placing of the time when Paul 
lived, said that " he had special experience in 
women s diseases, and had devoted himself to them 
with great industry and success. The midwives of 
the time were accustomed to go to him and ask his 
counsel with regard to accidents that happen during 
and after parturition. He willingly imparted his 
information, and told them what they should do. 
For this reason he came to be known as the Ob 
stetrician." Perhaps the term should be translated 


the man-midwife, for it was rather unusual for men 
to have much knowledge of this subject. His knowl 
edge of the phenomena of menstruation was as wide 
and definite. He knew a great deal of how to treat 
its disturbances. He seems to have been the first 
one to suggest that in metrorrhagia, with severe 
hemorrhage from the uterus, the bleeding might be 
stopped by putting ligatures around the limbs. This 
same method has been suggested for severe 
hemorrhage from the lungs as well as from the 
uterus in our own time. In hysteria he also sug 
gested ligature of the limbs, and it is easy to under 
stand that this might be a very strongly suggestive 
treatment for the severer forms of hysteria. It is 
possible, too, that the modification of the circulation 
to the nervous system induced by the shutting off 
of the circulation in large areas of the body might 
very well have a favorable physical effect in this af 
fection. Paul s description of the use of the spec 
ulum is as complete as that in any modern text 
book of gynaecology. 


Another distinguished Christian medical scientist 
was Theophilus Protosbatharius, who belonged to 
the court of the Greek Emperor Heraclius, in the 
seventh century. He seems to have had a life very 
full of interest and surprisingly varied duties. He 
was a bishop, and, at the same time, commander of 
the imperial bodyguard, and the author of a little 
work on the fabric of the human body. The most 
surprising chapter in the history of the book is 


that for some two centuries, in quite modern times, 
it was used as a text-book of anatomy at the Uni 
versity of Paris. It was printed in a number of 
editions early in the history of printing, at least 
one very probably before 1500, and several later. 

There are very interesting phases of medicine de 
lightfully surprising in their modernity to be found 
here and there in many of these early Christian 
writers on medicine. For instance, in a compend 
of medicine written by one Leo, who, under the Em 
peror Theophilus, seems to have been a prominent 
physician of Byzantium (the compend was written 
for a young physician just beginning practice), we 
find the following classification of hydrops or ab 
dominal dilatation : " There are three kinds ; the first 
is ascites, due to the presence of watery fluid, for 
which we do paracentesis; second, tyrnpany, when 
the abdomen is swollen from the presence of air or 
gas. This may be differentiated by percussion of 
the belly. When air is present the sound given 
forth is like that of a drum, while in the first form 
ascites the sound is like that from a sack [the word 
used is the same as for a wine sack] ; the third form 
is called anasarca, when the whole body swells." 

It has often been the subject of misunderstanding 
as to why medicine should have developed among the 
Latin Christian nations so much more slowly than 
among the Arabs during the early Middle Ages. 
Anyone who knows the conditions in which. Chris 
tianity came into existence in Italy will not be sur 
prised at that. The Arabs in the East were in con 
tact with Greek thought, and that is eminently 
prolific and inspiring. At the most, the Christians in 


Italy got their inspiration at second hand through 
the Romans. The Eomans themselves, in spite of in 
timate contact with Greek physicians, never made 
any important contributions to medical science, nor 
to science of any kind. Their successors, the Chris 
tians of Rome and Italy, then could scarcely be ex 
pected to do better, hampered especially, as they 
were, by the trying social conditions created by the 
invasion of the barbarians from the North. When 
ever the Christians were in contact with Greek 
thought and Greek medicine, above all, as at Alex 
andria, or in certain of the cities of the near East, 
we have distinguished contributions from them. 


That this is not a partial view suggested by the 
desire to make out a better case for Christianity in 
its relation to science will be very well understood, 
besides, from the fact that a number of the original 
physicians of Arab stock who attracted attention 
during the first period of Arabian medicine, that is, 
during the eighth and ninth centuries, were Chris 
tians. There are a series of physicians belonging 
to the Christian family Bachtischua, a name which 
is derived from Bocht Jesu, that is, servant of 
Jesus, who, from the middle of the eighth to the 
middle of the eleventh century, acquired great fame. 
The first of them, George (Dschordschis), after ac 
quiring fame elsewhere, was called to Bagdad by 
the Caliph El-Mansur, where, because of his med 
ical skill, he reached the highest honors. His son 
became the body-physician of Harun al-Raschid. 


In the third generation Gabriel (Dschibril) acquired 
fame and did much, as had his father and grand 
father, for the medicine of the time, by translations 
of the Greek physicians into Arabian. 

These men may well be said to have introduced 
Greek medicine to the Mohammedans. It was their 
teaching that aroused Moslem scholars from the 
apathy that had characterized the attitude of the 
Arabian people toward science at the beginning of 
Mohammedanism. As time went on, other great 
Christian medical teachers distinguished them 
selves among the Arabs. Of these the most prom 
inent was Messui the elder, who is also known as 
Janus Damascenus. Both he and his father prac 
tised medicine with great success in Bagdad, and his 
son became the body-physician to Harun al-Raschid 
either after or in conjunction with Gabriel Bach- 
tischua. Like his colleague or predecessor in of 
ficial position, he, too, made translations from the 
Greek into Arabic. Another distinguished Arabian 
Christian physician was Serapion the elder. He 
was born in Damascus, and flourished about the 
middle of the ninth century. He wrote a book on 
medicine called the " Aggregator," or " Brevi- 
arium," or " Practica Medicinae," which appeared 
in many printed editions within the century after 
the invention of printing. During the ninth cen 
tury, also, we have an account of Honein Ben Ischak, 
who is known in the West as Johannitius. After 
travelling much, especially in Greece and Persia, 
he settled in Bagdad, and, under the patronage of 
the Caliph Mamum, made many translations. He 
translated most of the old Greek medical writers, 


and also certain of the Greek philosophic and mathe 
matical works. The accuracy of his translations 
became a proverb. His compendium of Galen was 
the text-book of medicine in the "West for many cen 
turies. It was known as the " Isagoge in Artem 
Parvam Galeni." His son, Ishac Ben Honein, and 
his nephew, Hobeisch, were also famous as medical 
practitioners and translators. 

Still another of these Arabian Christians, who 
acquired a reputation as writers in medicine, was 
Alkindus. He wrote with regard to nearly every 
thing, however, and so came to be called the philoso 
pher. He is said altogether to have written and 
translated about two hundred works, of which 
twenty-two treat of medicine. He was a contem 
porary of Honein Ben Ischak in the ninth century. 
Another of the great ninth-century Christian physi 
cians and translators from the Greek was Kostaben 
Luka. He was of Greek origin, but lived in 
Armenia and made translations from Greek into 
Arabic. Nearly all of these men took not alone 
medical science, but the whole round of physical 
science, for their special subject. A typical example 
in the ninth century was Abuhassan Ben Korra, 
many of whose family during succeeding genera 
tions attracted attention as scholars. He became 
the astronomer and physician of the Caliph Mo- 
tadhid. His translations in medical literature were 
mainly excerpts from Hippocrates and Galen meant 
for popular use. These Christian translators, thor 
oughly scientific as far as their times permitted 
them to be, were wonderfully industrious in their 
work as translators, great teachers in every sense 


of the word, and they are the men who formed the 
traditions on which the greater Arabian physicians 
from Khazes onward were educated. 

It would be easy to think that these men, oc 
cupied so much with translations, and intent on the 
re-introduction of Greek medicine, might have de 
pended very little on their own observations, and 
been very impractical. All that is needed to coun 
teract any such false impression, however, is to 
know something definite about their books. Gurlt, 
in his " History of Surgery," has some quotations 
from Serapion the elder, who is often quoted by 
Rhazes. In the treatment of hemorrhoids Sera 
pion advises ligature and insists that they must be 
tied with a silk thread or with some other strong 
thread, and then relief will come. He says some 
people burn them medicinis acutis (touching 
with acids, as some do even yet), and some incise 
them with a knife. He prefers the ligature, how 
ever. He calmly discusses the removal of stones 
from the kidney by incision of the pelvis of the 
kidney through an opening in the loin. He con 
siders the operation very dangerous, however, but 
seems to think the removal of a stone from the 
bladder a rather simple procedure. His descrip 
tion of the technique of the use of a catheter and 
of a stylet with it, and apparently also of a guide 
for it in difficult cases, is extremely interesting. 
He suggests the opening of the bladder in the median 
line, midway between the scrotum and the anus, 
and the placing of a canula therein, so as to permit 
drainage until healing occurs. 

Even this brief review of the careers and the 


writings of the physicians of early Christian times 
shows how well the tradition of old Greek medicine 
was being carried on. There was much to hamper 
the cultivation of science in the disturbances of the 
time, the gradual breaking up of the Roman Empire, 
and the replacement of the peoples of southern 
Europe by the northern nations, who had come in, 
yet in spite of all this, medical tradition was well 
preserved. The most prominent of the con 
servators were themselves men whose opinions on 
problems of practical medicine were often of value, 
and whose powers of observation frequently cannot 
but be admired. There is absolutely no trace of 
anything like opposition to the development of med 
ical science or medical practice, but, on the contrary, 
everywhere among political and ecclesiastical 
authorities, we find encouragement and patronage. 
The very fact that, in the storm and stress of the 
succeeding centuries, manuscript copies of the writ 
ings of the physicians of this time were preserved 
for us in spite of the many vicissitudes to which 
they were subjected from fire, and war, and acci 
dents of various kinds for hundreds of years, until 
the coming of printing, shows in what estimation 
they were held. During this time they owed their 
preservation to churchmen, for the libraries and 
the copying-rooms were all under ecclesiastical 



Any account of Old-Time Makers of Medicine with 
out a chapter on the Jewish Physicians would indeed 
be incomplete. They are among the most important 
factors in medieval medicine, representing one of 
the most significant elements of medical progress. 
In spite of the disadvantages under which their race 
labored because of the popular feeling against them 
on the part of the Christians in the earlier centuries 
and of the Mohammedans later, men of genius from 
the race succeeded in making their influence felt not 
only on their own times, but accomplished so much 
in making and writing medicine as to influence many 
subsequent generations. Living the segregated life 
that as a rule they had to, from the earliest times 

1 My attention was called to the interesting story of the Jewish 
physicians of the Middle Ages and their scientific accomplishment 
while writing the article on Joseph Hyrtl for the Catholic En 
cyclopedia. His " Das Arabische und Hebraische in der Anatomic " 
(Wien, 1879) has some interestingly suggestive material on these im 
portant chapters of the history of medicine. (I owe my opportunity 
to consult it to the courtesy of the Surgeon-General s library.) 
Biographic material has been obtained from Carmoly s " History of 
the Jewish Physicians," translated by Dr. Dunbar for the Maryland 
Medical and Surgical Journal, some extra copies of which were 
printed by John Murphy and Co., Baltimore, about the middle of the 
nineteenth century. Baas and Haeser s Histories of Medicine and 
Puschmann and Pagel s " Handbook " provided additional material, 
and I have found Landau s " Geschichte der Jiidischen Aerzte " (Ber 
lin, 1895) of great service. 



(the Ghettos have only disappeared in the nineteenth 
century), it would seem almost impossible for 
them to have done great intellectual work. It 
is one of the very common illusions, however, 
that great intellectual work is accomplished mainly 
in the midst of comfortable circumstances and 
as the result of encouraging conditions. Most 
of our great makers of medicine at all times, 
and never more so than during the past century, 
have been the sons of the poor, who have had 
to earn their own living, as a rule, before 
they reached manhood, and who have always had the 
spur of that necessity which has been so well called 
the mother of invention. Their hard living condi 
tions probably rather favored than hampered their 
intellectual accomplishments. 

It is not unlikely that the difficult personal circum 
stances in which the Jews were placed had a good 
deal to do at all times with stimulating their am 
bitions and making them accomplish all that was in 
them. Certain it is that at all times we find a won 
derful power in the people to rise above their con 
ditions. With them, however, as with other peoples, 
luxury, riches, comfort, bring a surfeit to initiative 
and the race does not accomplish so much. At vari 
ous times in the early Middle Ages, particularly, we 
find Jewish physicians doing great work and obtain 
ing precious acknowledgment for it in spite of the 
most discouraging conditions. Later it is not un 
usual to find that there has been a degeneration into 
mere money-making as the result of opportunity 
and consequent ease and luxury. At a number of 
times, however, both in Christian and in Moham- 


medan countries, great Jewish physicians arose 
whose names have come to us and with whom every 
student of medicine who wants to know something 
about the details of the course of medical history 
must be familiar. There are men among them 
who must be considered among the great lights 
of medicine, significant makers always of the 
art and also in nearly all cases of the science of 

A little consideration of the history of the Jewish 
people and their great documents eliminates any sur 
prise there may be with regard to their interest in 
medicine and successful pursuit of it during the 
Middle Ages. The two great collections of Hebrew 
documents, the Old Testament and the Talmud, con 
tain an immense amount of material with reference 
to medical problems of many kinds. Both of these 
works are especially interesting because of what they 
have to say of preventive medicine and with regard 
to the recognition of disease. Our prophylaxis 
and diagnosis are important scientific departments 
of medicine dependent on observation rather than 
on theory. While therapeutics has wandered into 
all sorts of absurdities, the advances made in pro 
phylaxis and in diagnosis have always remained 
valuable, and though at times they have been for 
gotten, re-discovery only emphasizes the value of 
preceding work. It is because of what they contain 
with regard to these two important medical subjects 
that the Old Testament and the Talmud are land 
marks in the history of medicine as well as of re 

Baas, in his " Outlines of the History of Medi- 


cine," says: " It corresponds to the reality in both 
the actual and chronological point of view to con 
sider the books of Moses as the foundation of sani 
tary science. The more we have learned about 
sanitation in the prophylaxis of disease and in the 
prevention of contagion in the modern time, the 
more have we come to appreciate highly the teach 
ings of these old times on such subjects. Moses 
made a masterly exposition of the knowledge neces 
sary to prevent contagious disease when he laid 
down the rules with regard to leprosy, first as to 
careful differentiation, then as to isolation, and 
finally as to disinfection after it had come to be sure 
that cure had taken place. The great lawgiver could 
insist emphatically that the keeping of the laws of 
God not only was good for a man s soul but also for 
his body." 

With this tradition familiarly known and deeply 
studied by the mass of the Hebrew people, it is no 
surprise to find that when the next great Hebrew 
development of religious writing came in the Tal 
mud during the earlier Middle Ages, that also con 
tains much with regard to medicine, not a little of 
which is so close to absolute truth as never to be 
out of date. Friedenwald, in his " Jewish Phy 
sicians and the Contributions of the Jews to the 
Science of Medicine, a lecture delivered before the 
Gratz College of Philadelphia fifteen years ago, 
summed up from Baas " History of Medicine " the 
instructions in the Talmud with regard to health and 
disease. The summary represents so much more of 
genuine knowledge of medicine and surgery than 
might be expected at the early period at which it was 


written, during the first and second century of our 
era, that it seems well to quote it at some length. 

" Fever was regarded as nature s effort to expel 
morbific matter and restore health ; which is a much 
safer interpretation of fever, from a practical point 
of view, than most of the theories- hearing on this 
point that have been taught up to a very recent 
period. They attributed the halting in the hind legs 
of a lamb to a callosity formed around the spinal 
cord. This was a great advance in the knowledge 
of the physiology of the nervous system. An emetic 
was recommended as the best remedy for nausea. 
In many cases no better remedy is known to-day. 
They taught that a sudden change in diet was injuri 
ous, even if the quality brought by the change was 
better. That milk fresh from the udder was the best. 
The Talmud describes jaundice and correctly 
ascribes it to the retention of bile, and speaks of 
dropsy as due to the retention of urine. It teaches 
that atrophy or rupture of the kidneys is fatal. In 
duration of the lungs (tuberculosis) was regarded 
as incurable. Suppuration of the spinal cord had 
an early, grave meaning. Rabies was known. The 
following is a description given of the dog s condi 
tion : < His mouth is open, the saliva issues from his 
mouth; his ears drop; his tail hangs between his 
legs; he runs sideways, and the dogs bark at him; 
others say that he barks himself, and that his voice 
is very weak. No man has appeared who could say 
that he has seen a man live who was bitten by a 
mad dog. The description is good, and this prog 
nosis as to hydrophobia in man has remained un 
altered till in our day when Pasteur published his 
startling revelation. The anatomical knowledge of 
the Talnmdists was derived chiefly from dissection 
of the animals. As a very remarkable piece of prac 
tical anatomy for its very early date is the procuring 


of the skeleton from the body of a prostitute by the 
process of boiling, by Eabbi Ishmael, a physician, 
at the close of the first century. He gives the num 
ber of bones as 252 instead of 232. The Talmudists 
knew the origin of the spinal cord at the foramen 
magnum and its form of termination ; they described 
the oesophagus as being composed of two coats ; they 
speak of the pleura as the double covering of the 
lungs ; and mention the special coat of fat about the 
kidneys. They had made progress in obstetrics ; de 
scribed monstrosities and congenital deformities; 
practised version, evisceration, and Caesarian section 
upon the dead and upon the living mother. A. H. 
Israels has clearly shown in his Dissertatio His- 
torico-Medica Inauguralis that Caesarian section, ac 
cording to the Talmud, was performed among the 
Jews with safety to mother and child. The surgery 
of the Talmud includes a knowledge of dislocation of 
the thigh bone, contusions of the skull, perforation 
of the lungs, oesophagus, stomach, small intestines, 
and gall bladder; wounds of the spinal cord, wind 
pipe, of fractures of the ribs, etc. They described 
irnperforate anus and how it was to be relieved by 
operation. Chauina Ben Chania inserted natural 
and wooden teeth as early as the second century, 
C. E." 

There is a famous summing up of the possibilities 
of life and happiness in the Talmud that has been 
often quoted its possible wanting in gallantry be 
ing set down to the times in which it was written. 
" Life is compatible with any disease, provided the 
bowels remain open ; any kind of pain, provided the 
heart remain unaffected; any kind of uneasiness, pro 
vided the head is not attacked; all manner of evils, 
except it be a bad woman. 

There are many other interesting suggestions in 


the Talmud. Sometimes they have come to be gen 
erally accepted in the modern time, sometimes they 
are only curious notions that have not, however, lost 
all their interest. The crucial incision for carbuncle 
is a typical example of the first class and the sug 
gestion of the removal of superfluous fat from within 
the abdomen or in the abdominal wall itself by 
operation is another. That they had some idea of 
the danger of sepsis may be gathered from the fact 
that they suspected iron surgical instruments and 
advised the use of others of less enduring character. 
The Talmud itself was indeed a sort of encyclo 
pedia in which was gathered knowledge of all kinds 
from many sources. It was not particularly a book 
of medicine, though it contains so many medical 
ideas. In many parts of it the authors regard for 
science is emphatically expressed. Landau, in his 
" History of Jewish Physicians," closes his account 
of the Talmud with this paragraph : 

" I conclude this brief review of Talmudic medi 
cine with some reference to how high the worth of 
science was valued in this much misunderstood work. 
In one place we have the expression occupation with 
science means more than sacrifice. In another 
science is more than priesthood and kingly dig 
nity. ?1 

course there are many absurd things "recommended in the Tal 
mud. "We cannot remind ourselves too often, however, that there have 
been absurd things at all times in medicine, and especially in therapeu 
tics. It is curious how often some of these absurdities have repeated 
themselves. We are liable to think it very queer that men should have 
presumed, or somehow jumped to the conclusion, that portions of ani 
mals might possess wonderful virtue for the healing of diseases of the 
corresponding special parts of man. We ourselves, however, within a 


After all this of national tradition in medicine be 
fore and after Christ, it is only what we might quite 
naturally expect to find, that there is scarcely a cen 
tury of the Middle Ages which does not contain at 
least one great Jewish physician and sometimes 
there are more. Many of these men made distinct 
contributions to medical science and their names 
have been held in high estimation ever since. Per 
haps I should say that they were held in high estima 
tion until that neglect of historical studies which 
characterized the eighteenth century developed, and 
that there has been a reawakening of interest in our 
time. We forget this curious decadence of the later 
seventeenth and eighteenth centuries which did so 
much to obscure history and especially the history 
of the sciences. Fortunately the scholars of the six 
teenth and early seventeenth centuries accomplished 
successfully the task of printing many of the books 
of these old-time physicians and secured their pub 
lication in magnificent editions. These were bought 
eagerly by scholars and libraries all over Europe 

little more than a decade, had a phase of opotherapy how much less 
absurd it seems under that high-sounding Greek term that was appar 
ently very learned in its scientific aspects yet quite as absurd as many 
phases of old-time therapy, as we look at it. "We administered cardin 
for heart disease and nephrin for kidney trouble, cerebrin for insanity 
(save the mark !), and even prostate tissue for prostatism and with re 
ported good results ! How many of us realize now that in this we were 
only repeating the absurdities, so often made fun of in old medicine, 
with regard to animal tissue and excrement therapeutics? The Talmud 
has many conclusions with regard to the symptoms of patients drawn 
from dreams ; as, for instance, it is said to be a certain sign of sanguine 
ous plethora when one dreams of the comb of a cock. One phase of 
our psycho-analysis in the modern time, however, has taken us back to 
an interpretation of dreams different of course from this, yet analogous 
enough to be quite striking. 


in spite of the high price they commanded in that 
era of slow, laborious printing. The Renaissance 
exhibits some of its most admirable qualities in its 
reverence for these old workers in science and above 
all for the careful preparation by its scholars of the 
text of these first editions of old-time physicians. 
The works have often been thus literally preserved 
for us, for some of them at least would have disap 
peared among the vicissitudes of the intervening 
time, most of which was anything but favorable to 
the preservation of old-time works, no matter what 
their content or value. 

During the second and third centuries of our era, 
while the Talmudic writings were taking shape, three 
great Jewish physicians came into prominence. 
The first of them, Chanina, was a contemporary of 
Galen. According to tradition, as we have said, he 
inserted both natural and artificial teeth before the 
close of the second century. The two others were 
Eab or Raw and Samuel. Rab has the distinction 
of having studied his anatomy from the human body. 
According to tradition he did not hesitate to spend 
large sums of money in order to procure subjects 
for dissection. At this time it is very doubtful 
whether Galen, though only of the preceding gen 
eration, ever had the opportunity to study more than 
animals or, at most, a few human bodies. Samuel, 
the third of the group, was an intimate friend of 
Rab s, perhaps a disciple, and his fame depends 
rather on his practice of medicine than of research 
in medical science. He was noted for his practical 
development of two specialties that cannot but seem 
to us rather distant from each other. His reputa- 


tion as a skilful obstetrician was only surpassed by 
the estimation in which he was held as an oculist. 
He seems to have turned to astronomy as a hobby, 
and was highly honored for his knowledge of this 
science. Probably there is nothing commoner in the 
story of great Jewish physicians than their success 
ful pursuit of some scientific subject as a hobby and 
reaching distinction in it. Their surplus intellectual 
energy needed an outlet besides their vocation, and 
they got a rest by turning to some other interest, 
often accomplishing excellent results in it. Like 
most great students with a hobby, the majority of 
them were long-lived. Their lives are a lesson to a 
generation that fears intellectual overwork. 

During the fourth century we have a number of 
very interesting traditions with regard to a great 
Jewish physician, Abba Ournna, to whom patients 
flocked from all over the world. He seems particu 
larly to have been anxious to make his services avail 
able to the scholars of his time. He looked upon 
them as brothers in spirit, fellow-laborers whose in 
vestigations were as important as his own and Avhose 
labors for mankind he hoped to extend by the helpful 
ness of his profession. In order that it might be easy 
for them to come to him without feeling abashed by 
their poverty, and yet so that they might pay him 
anything that they thought they were able to, he 
hung up a box in his anteroom in which each patient 
might deposit whatever he felt able to give. His 
kindliness towards men became the foundation for 
many legends. Needless to say he was often im 
posed upon, but that seems to have made no differ 
ence to him, and he went on straightforwardly doing 


what he thought he ought to do, regardless of the 
devious ways of men, even those whom he was gen 
erously assisting. "While we do not know much of 
his scientific medicine, we do know that he was a 
fine example of a practitioner of medicine on the 
highest professional lines. 

With the foundation of the school at Djondisabour 
in Arahistan or Khusistan by the Persian monarch 
Chosroes, some Jewish physicians come into promi 
nence as teachers, and this is one of the first impor 
tant occasions in history when they teach side by 
side with Christian colleagues. Djondisabour seems 
distant from us now, lying as it does in the province 
just above the head of the Persian Gulf, and it is a 
little hard to understand its becoming a centre of 
culture and education, yet according to well- 
grounded historical traditions students flocked here 
from all parts of the world, and its medical instruc 
tion particularly became famous. According to the 
documents and traditions that we possess, clinical 
teaching was the most significant feature of the 
school work and made it famous. As a consequence 
graduates from here were deemed fully qualified to 
become professors in other institutions and were 
eagerly sought by various medical schools in the 
East. * 

With the rise of the strong political power of the 
Mohammedans enough of peace came to the East at 
least to permit the cultivation of arts and sciences 
to some extent again, and then at once the eminence 
of Jewish physicians, both as teachers and practi 
tioners of medicine, once more becomes manifest. 
The first of the race who comes into prominence is 


Maser Djawah Ebn Djeldjal, of Basra. To him we 
owe probably more than to anyone else the preserva 
tion of old scientific writings and the cultivation of 
arts and sciences by the Mohammedans. He pre 
vailed on Caliph Moawia I, whose physician he had 
become, to cause many foreign works, and especially 
those written in Greek, to be translated into Arabic. 
He seems to have taken a large share of the labor 
of the translation on himself and prevailed upon 
his pupil, the son of Moawia, to translate some works 
on chemistry. The translation for which Maser 
Djawah is best known is that of the Pandects of 
Haroun, a physician of Alexandria. The transla 
tion of this work was made toward the end of the 
seventh century. Unfortunately the " Pandects " 
has not come down to us, either in original or trans 
lation, but we have fragments of the translation 
preserved by Rhazes, the distinguished Arabian 
medical writer and physician of the ninth century, 
and there seems no doubt that it contained the first 
good description of smallpox, a chapter in medicine 
that is often though incorrectly attributed to 
Rhazes himself. Rhazes quoted Maser Djawah 
freely and evidently trusted his declarations im 

The succeeding Caliphs of the first Arabian dy 
nasty did not exhibit the same interest in education, 
and above all in science, that characterized Moawia. 
Political ambition and the desire for military glory 
seem to have filled up their thoughts and perhaps 
they had not the good fortune to fall under the in 
fluence of physicians so wise and learned as Maser 
Djawah. More probably, however, they themselves 


lacked interest. Toward the end of the seventh cen 
tury they were succeeded by the Abbassides. Al- 
mansor, the second Caliph of this dynasty, was at 
tacked by a dangerous disease and sent for a 
physician of the Nestorian school. After his res 
toration to health he became a liberal patron of 
science and especially medical science. The new city 
of Bagdad, which had become the capital of the realm 
of the Abbassides, was enriched by him with a large 
number of works on medicine, which he caused to be 
translated from the Greek. He did not confine him 
self to medicine, however, but also brought about 
translations of works with regard to other sciences. 
One of these, astronomy, was a favorite. He made 
it a particular point to search out and encourage the 
translation of such books as had not previously been 
translated from Greek into Arabic. While he pro 
vided a translation of Ptolemy he also had transla 
tions made of Aristotle and Galen. 

It is not surprising, then, that the school of Bag 
dad became celebrated. Jewish physicians seem to 
have been most prominent in its foundation, and the 
most distinguished product of it is Isaac Ben Ernran, 
almost as celebrated as a philosopher as he is as a 
physician. One of his expressions with regard to 
the danger of a patient having two physicians whose 
opinions disagree with regard to his illness has been 
deservedly preserved for us. Zeid, an Emir of one 
of the chief cities of the Arabs in Barbary, fell ill 
of a tertian fever and called Isaac and another phy 
sician in consultation. Their opinions were so widely 
in disaccord that Isaac refused to prescribe any 
thing, and when the Emir, who had great confidence 


in him, demanded the reason, he replied, " disagree 
ment of two physicians is more deadly than a tertian 
fever." This Isaac, who is said to have died in 799, 
is the great Jewish physician, one of the most im 
portant members of the profession in the eighth cen 
tury. His principal work was with regard to poisons 
and the symptoms caused by them. This is often 
quoted by medical writers in the after time. 

The prominent Jewish physician of the ninth 
century was Joshua Ben Xun. Haroun al-Kaschid, 
whose attempts to secure justice for his people are 
the subject of so much legendary lore, and whose 
place in history may be best recalled by the fact that 
he is a contemporary of Charlemagne, was particu 
larly interested in medicine. He founded the city of 
Tauris as a memorial of the cure of his wife. He 
was a generous patron of the school of Djondisabour 
and established a medical school also at Bagdad. He 
provided good salaries for the professors, insisted on 
careful examinations, and raised the standard of 
medical education for a time to a noteworthy de 
gree. The greatest teacher of this school at Bagdad 
was Joshua Ben Xun, sometimes known as the Eabbi 
of Seleucia. His teaching attracted many students 
to Bagdad and his fame as one of the great practi 
tioners of medicine of this time brought many pa 
tients. Among his disciples was John Masuee, whose 
Arabian name is so different, Yahia Ben Masoviah, 
that in order to avoid confusion in reading it is im 
portant to know both. Almost better known, per 
haps, at this time was Abu Joseph Jacob Ben Isaac 
Kendi. Fortunately for the after time, these men 
devoted themselves not only to their own observa- 


tions and writings but made a series of valuable 
translations. Joshua Ben Nun seems to have been 
particularly zealous in this matter, following the 
example of Maser Djawah of Basra. 

Bagdad then became a centre for Arabian culture. 
Mahmoud, one of Haroun s successors, provided in 
Bagdad a refuge for the learned men of the East 
who were disturbed by the wars and troubles of the 
time. He became a liberal patron of literature and 
education. When the Emperor Michael III of Con 
stantinople was conquered in battle, one of the obli 
gations imposed upon him was to send many camel 
loads of books to Bagdad, and Aristotle and Plato 
were studied devotedly and translated into Arabic. 
The era of culture affected not only the capital but 
all the cities, and everywhere throughout the Ara 
bian empire schools and academies sprang up. We 
have records of them at Basra, Samarcand, Is 
pahan. From here the thirst for education spread to 
the other cities ruled by the Mohammedans, and each 
town became affected by it. Alexandria, the cities 
of the Barbary States, those of Sicily and Provence, 
where Moorish influences were prominent, and of 
distant Spain, Cordova, Seville, Toledo, Granada, 
Saragossa, all took up the rivalry for culture which 
made this a glorious period in the history of the 
intellectual life. 

Already, in the chapter on " Great Physicians in 
Early Christian Times," I have pointed out that 
many of the teachers of the Arabs were Christian 
physicians. Here it is proper to emphasize the other 
important factor in Arabian medicine, the Jewish 
physicians, who influenced the great Arabian rulers, 


and were the teachers of the Arabs in medicine and 
science generally. These Christian and Jewish phy 
sicians particularly encouraged the translation of 
the works of the great Greek physicians and thus 
kept the Greek medical tradition from dying out. It 
is not until the end of the ninth, or even the begin 
ning of the tenth, century that we begin to have 
important contributors to medicine from among the 
Arabs themselves. Even at this time they have dis 
tinguished rivals among Jewish physicians. Indeed 
these acquired such a reputation that they became 
the physicians to monarchs and even high ecclesi 
astics, and we find them nearly everywhere through 
out Europe. Their success was so great that it is 
not surprising that after a time the vogue of the 
Jewish physicians should have led to jealousy of 
them and to the passage of laws and decrees limiting 
their sphere of activity. 

The great Jewish physician of the ninth century 
was Isaac Ben Soliman, better known as Isaac el 
Israili, and who is sometimes spoken of as d Israeli. 
He was a pupil of Isaac Ben Amram the younger, 
probably a grandson of another Isaac Ben Amram, 
who, after having become famous in Bagdad, went 
to Cairo and became the physician of the Emir Zi- 
jadeth III. The younger Isaac established a school, 
and it was with him that Israeli obtained his intro 
duction to medicine. He practised first as an oculist 
and then became body-physician to the Sultan of 
Morocco. Because of the sympathy of his character 
and his unselfishness he acquired great popularity. 
Hyrtl refers to him respectfully as that scholarly 
son of Israel. Curiously enough, considering racial 


feeling in the matter, he never married, and when 
asked why he had not, and whether he did not think 
that he might regret it, he replied, " I have written 
four books through which my memory will be better 
preserved than it would be by descendants." The 
four books are his " Treatise on Fevers," his 
" Treatise on Simple Medicines and Ailments," a 
treatise on the " Elements," and a treatise " On the 
Urine." Besides these, we have from him shorter 
works, " On the Pulse," " On Melancholy," and 
" On Dropsy." His hope with regard to his fame 
from these works was fulfilled, for they were printed 
as late as 1515 at Leyden, and Sprengel declared 
them the best compendium of simple remedies and 
diet that we have from the Arabian times. One of 
his translators into Latin has called him the monarch 
of physicians. 

Some of his maxims are extremely interesting in 
the light of modern notions on the same subjects. He 
declared emphatically that " the most important 
duty of the physician is to prevent illness." " Most 
patients get better without much help from the phy 
sician by the power of nature." He emphasized his 
distrust of using many medicines at the same time 
in the hope that some of them would do good. He 
laid it down as a rule : Employ only one medicine 
at a time in all your cases and note its effects care 
fully. He was as wise with regard to medical ethics 
as therapeutics. He advised a young physician, 
" Never speak unfavorably of other physicians. 
Every one of us has his lucky and unlucky hours." 
It is pleasant to learn that the old gentleman lived 
to fill out a full hundred years of life, and that in his 


declining years he was surrounded by the good will 
and the affection of many who had learned to know 
his precious qualities of heart and mind. More than 
of any other class of physicians do we find the large 
human sympathies of the Jewish physicians of the 
Middle Ages praised by their contemporaries and 
succeeding generations. 

During the next centuries a number of Jewish phy 
sicians became prominent, though none of them until 
Maimonides impressed themselves deeply upon the 
medical life of their own and succeeding centuries. 
Very frequently they were the physicians to royal 
personages. Zedkias, for instance, was the physician 
to Louis the Pious and later to his son Charles the 
Bald. His reputation as a physician was great 
enough to give him the popular estimation of a ma 
gician, but it did not save him from the accusation 
of having poisoned Charles when that monarch died 
suddenly. There seem to be no good grounds, how 
ever, for the accusation. There were a number of 
schools of medicine, in Sicily and the southern part 
of Italy, in which Jewish, Arabian, and Christian 
physicians taught side by side. One of these teachers 
was Jude Sabatai Ben Abraham, usually known by 
the name of Donolo, who was famous both as a writer 
on medicine and on astronomy. Donolo studied and 
probably taught at Tarentum, and there were similar 
schools at Palermo, at Bari, and then later on the 
mainland at Salerno. The foundation of Salerno, 
in which Jewish physicians also took part, we shall 
discuss later in the special chapter devoted to that 

One of the great translators whose work meant 


very much for the medical science of his own and 
succeeding generations was the distinguished Jewish 
physician, Far ad j Ben Salim, sometimes spoken of 
as Farachi Faragut or Ferrarius, who was born at 
Girgenti in Sicily. He made his medical studies in 
Salerno and did his work under the patronage of 
Charles of Anjou towards the end of the thirteenth 
century. His greatest work is the translation of the 
whole of the " Continens " of Rhazes. The trans 
lation is praised as probably the best of its time 
made in the Middle Ages. Farad j came at the end 
of a great century, when the intellectual life of Eu 
rope had reached a high power of expression, and it 
is not surprising that he should have proved equal to 
his environment. This translation has also some ad 
ditions made by Faradj himself, notably a glossary 
of Arabian names. 

In Spain also Jewish physicians rose to distinc 
tion. The most distinguished in the tenth century 
was Chasdai Ben Schaprut. Like many other of the 
great physicians of this time, he had studied astron 
omy as well as the medical sciences. He became the 
physician of the Caliph Abd-er-Rahman III of Cor 
dova. He seems also to have exercised some of 
the functions of Prime Minister to the Caliph, and 
took advantage of diplomatic relations between his 
sovereign and the Byzantine Emperor to obtain some 
works of Dioscorides. These he translated into 
Arabian with the help of a Greek monk, whom he 
seems also to have secured through the diplomatic 
relations. Undoubtedly he did much to usher in that 
enthusiasm for education and study which charac 
terized the next centuries, the eleventh and twelfth, 


at Cordova in Spain, when such men as Avenzoar, 
Avicenna, and Averroes attracted the attention of 
the educational world of the time. Jewish writers 
have sometimes claimed one of the most distin 
guished of these, Avenzoar himself, as a Jew, but 
Hyrtl and other good authorities consider him of 
Arabic extraction and point to the fact that his an 
cestors bore the name of Mohammed. This is not 
absolutely conclusive evidence, but because of it I 
have preferred to class Avenzoar among the Arabian 

The one historical fact of importance for us is that 
everywhere in Europe at that time Jews were being 
accorded opportunities for the study and practice of 
medicine. There are local incidents of persecution, 
but we are not so far away from the feelings that 
brought these about as to misunderstand them or to 
think that they were anything more than local, pop 
ular manifestations. The more we know about the 
details of the medical history of these times the 
deeper is the impression of academic freedom and of 
opportunities for liberal education. 

Much has been said about the intolerance of ec 
clesiastical authorities toward the Jews, and of 
Church decrees that either absolutely forbade their 
practice of the medical profession and their devo 
tion to scientific study, or at least made these pur 
suits much more difficult for them than for others. 
Of course it has to be conceded, even by those who 
most insistently urge the existence of formal legis 
lation in the matter, that in spite of these decrees 
and intolerance and opposition, Jews continued to 
practise medicine and to be the chosen physicians of 


kings and even of high ecclesiastical dignitaries, as 
well indeed of the Popes themselves. This, it is 
usually declared, must be attributed to the surpass 
ing skill of the Jewish physicians, causing men to 
overcome their prejudices and override even their 
own legal regulations. There is no doubt at all about 
the skill of Jewish physicians at many times during 
the Middle Ages. There is no doubt also of the sen 
timent of opposition that often developed between 
the Christian peoples and the Jews. Any excuse is 
good enough to justify men, to themselves at least, 
in putting obstacles in the paths of those who are 
more successful than they are themselves. Keligion 
often became a cloak for ill-will and persecution. 

The state of affairs that has been presumed how 
ever, according to which laws and decrees were being 
constantly issued forbidding the practice of medicine 
to Jews by the ecclesiastical authorities, while at 
the same time they themselves and those who were 
nearest to them were employing Jewish physicians, 
is an absurdity that on the face of it calls for investi 
gation of the conditions and from its very appear 
ance would indicate that the ordinary historical 
assumption in the matter must be wrong. 

I have been at some pains, then, to try to find out 
just what were the conditions in Europe with 
regard to the practice of medicine by the Jews. 
There is no doubt that at Salerno, where the influ 
ence of the Benedictines was very strong and where 
the influence of the Popes and the ecclesiastical au 
thorities was always dominant, full liberty of study 
ing and teaching was from the earliest days allowed 
to the Jews. Down at Montpellier it seems clear that 


Jewish physicians had a large part in the foundation 
of the medical school, and continued for several cen 
turies to be most important factors in the mainte 
nance of its reputation and the upbuilding of that 
fame which draw students from even distant parts 
of Europe to this medical school of the south of 
France. During the ninth, tenth, eleventh, and 
twelfth centuries Jewish physicians were frequently 
in attendance on kings and the higher nobility, on 
bishops and archbishops, cardinals, and even Popes. 
Every now and then the spirit of intolerance among 
the populace was aroused, and occasionally the death 
of some distinguished patient while in a Jewish phy 
sician s hands was made the occasion for persecu 
tion. We must not forget, after all, that even as late 
as Elizabeth s time, when Shakespeare wrote " The 
Merchant of Venice," he was taking advantage of 
the popular sentiment aroused by the execution of 
Lopez, the Queen s physician, for a real or supposed 
participation in a plot against her Majesty s life. 
Shylock was presented the next season for the sake 
of adventitious popularity that would thus accrue 
to the piece. The character was played so as to 
depict all the worst traits of the Jew, and was scorn 
fully laughed at at every representation. This is 
an index of the popular feeling of the time. Bitter 
intolerance of the Jew has continued. Down almost 
to our own time the Ghettos have existed in Europe, 
and popular tumults against them continue to occur. 
Quite needless to say, these do not depend on Chris 
tianity, but on defective human nature. 

During the Middle Ages the best possible criterion 
of the attitude of the Church authorities towards the 


Jews is to be found in the legislation of Pope Inno 
cent III. He is the greatest of the Popes of the 
Middle Ages; he shaped the policy of the Church 
more than any other; his influence was felt for many 
generations after his own time. His famous edict 
with regard to them was well known : Let no Chris 
tian by violence compel them to come dissenting or 
unwilling to Baptism. Further, let no Christian ven 
ture maliciously to harm their persons without a 
judgment of the civil power or to carry off their 
property or change their good customs which they 
have hitherto in that district which they inhabit." 
Innocent himself and several of his predecessors and 
successors are known to have had Jewish physicians. 
Example speaks even louder than precept, and the 
example of such men must have been a wonderful 
advertisement for the Jewish physicians of the time. 
Besides Innocent III, many of the Popes of the 
twelfth and thirteenth centuries issued similar decrees 
as to the Jews. It may be recalled that this was the 
time when the Papacy was most powerful in Europe 
and when its decrees had most weight in all coun 
tries. Alexander II, Gregory IX, and Innocent IV 
all issued formal documents demanding the protec 
tion of the Jews, and especially insisting that they 
must not be forced to receive Baptism nor disturbed 
in the celebration of their festivals. Clement VI did 
the same thing in the next century, and even offered 
them a refuge from persecution throughout the rest 
of France at Avignon. Distinguished Jewish schol 
ars, who know the whole story from careful study, 
have given due credit to the Popes for all that they 
did for their people. They have even declared that 


if the Jews were not exterminated in many of the 
European countries it was because of the protection 
afforded by the Church. We have come to realize in 
recent years that persecution of the Jews is not at all 
a religious matter, but is due to racial prejudice and 
jealousy of their success by the peoples among whom 
they settle. All sorts of pretexts are given for this 
persecution at all times. Formal Church documents 
and the personal activities of the responsible Church 
officials show that during the Middle Ages the Church 
was a protector and not a persecutor of the Jews. 

There is abundant historical authority for the 
statement that the Popes were uniformly beneficent 
in their treatment of the Jews. In order to demon 
strate this there is no need to quote Catholic his 
torians, for non-Catholics have been rather emphatic 
in bringing it out. Neander, the German Protestant 
historian, for instance, said : 

" It was a ruling principle with the Popes after 
the example of their great predecessor, Gregory the 
Great, to protect the Jews in the rights which had 
been conceded to them. "When the banished Popes 
of the twelfth century returned to Rome, the Jews 
went forth in their holiday garments to meet them, 
bearing before them the thora, and Innocent II, 
on an occasion of this sort, blessed them." 

English non-Catholic historians can be quoted to 
the same effect. The Anglican Dean Milman, for in 
stance, said: " Of all European sovereigns, the 
Popes, with some exceptions, have pursued the most 
humane policy towards the Jews. In Italy, and even 
in Eome, they have been more rarely molested than 
in the other countries." 


Hallam has expressed himself to the same effect, 
especially as regards the protection afforded to the 
Jew by the laws of the Church from the injustice of 
those around him. Laws sometimes fail of their 
purpose and the persecuting spirit of the populace 
is often hard to control, but everything that the cen 
tral authority could do to afford protection was done 
and essential justice was enshrined in the Church 

Prominent ecclesiastics would naturally follow the 
lines laid down by their Papal superiors. The atti 
tude of those whose lives mark epochs in the history 
of Christianity and who had more to do almost with 
the shaping of the policy of the Church at many 
times than the Popes themselves, can be quoted 
readily to this same effect. Neander has called par 
ticular attention to St. Bernard s declarations with 
regard to the evils that would follow any tolerance 
of such an abuse as the persecution of the Jews. 

The most influential men of the Church protested 
against such un-Christian fanaticism. When the 
Abbot Bernard of Clairvaux was rousing up the 
spirit of the nations to embark in the second crusade, 
and issued for this purpose, in the year 1146, his let 
ters to the Germans (East Franks), he at the same 
time warned them against the influence of those 
enthusiasts who strove to inflame the fanaticism of 
the people. He declaimed against the false zeal, 
without knowledge, which impelled them to murder 
the Jews, a people who ought to be allowed to 
live in peace in the country." 

But it has been said that there are decrees against 
Jewish physicians, issued especially in the south of 


France, by various councils and synods of the 
Church. Attention needs to be called at once to the 
fact that these are entirely local regulations and 
have nothing to do with the attitude of the Church 
as a whole, but represent what the ecclesiastical au 
thorities of a particular part of the country deem 
necessary for some special reason in order to meet 
local conditions. Indeed at the end of the thirteenth 
and the early fourteenth century, when these de 
crees were being issued in France, full liberty was 
allowed in Italy, and there were no restrictions 
either as to medical practice or education founded on 
adhesion to Judaism. 

What need to be realized in order to understand 
the issuance of certain local ecclesiastical regula 
tions forbidding Jews to practise medicine are the 
special conditions which developed in France at this 
time. Many Jews had emigrated from Spain to 
France, and the reputation acquired by Jewish phy 
sicians at Montpellier led to a number of the race 
taking up the practice of medicine without any fur 
ther qualification than the fact that they were Jews. 
That gave them a reputation for curative powers of 
itself because of the fame of some Jewish doctors 
and their employment by the nobility and the highest 
ecclesiastics. It was hard to regulate these wander 
ing physicians. As a consequence of this, the fac 
ulty at Paris, always jealous of its own rights and 
those of its students, at the beginning of the four 
teenth century absolutely forbade Jews from prac 
tising on Christian patients within its jurisdiction. 
Of course the faculty of the University of Paris was 
dominated by ecclesiastical authorities. The medical 


school was, however, almost entirely independent of 
ecclesiastical influence, and was besides largely re 
sponsible for this decree. It was felt that something 
had to be done to stop the evil that had arisen and 
the charlatanry and quackery which was being prac 
tised. This was, however, rather an attempt to 
regulate the practice of medicine and keep it in the 
hands of medical school graduates than an example 
of intolerance towards the Jews. Practically no 
Jews had graduated at its university, Montpellier 
being their favorite school, and Paris was not a little 
jealous of its rights to provide for physicians from 
the northern part of France. We have not got 
away from manifestations of that spirit even 
yet, as our non-reciprocating state medical laws 

During the next quarter of a century decrees not 
unlike those of the University of Paris were issued 
in the south of France, especially in Provence and 
Avignon. Anyone who knows the conditions which 
existed in the south of France at this time with re 
gard to medical practice will be aware that a number 
of attempts were made by the ecclesiastical authori 
ties just at this time to regulate the practice of medi 
cine. Great abuses had crept in. Almost anyone 
who wished could set up as a physician, and those 
who were least fitted were often best able to secure 
a large number of patients by their cleverness, their 
knowledge of men, and their smooth tongues. The 
bishops of various dioceses met, and issued decrees 
forbidding anyone from practising medicine unless 
he was a graduate of the medical school of the neigh 
boring University of Montpellier. After a time it was 


found that the greatest number of violators of these 
decrees were Jews. Accordingly special regulations 
were made against them. They happen to be ec 
clesiastical regulations, because no other authority at 
that time claimed the right to regulate medical edu 
cation and the practice of medicine. 

What is sure is that many Jewish physicians 
reached distinction under Christian as well as Ara 
bian rulers at all times during the Middle Ages. It 
would be quite impossible in the limited space at 
command here to give any adequate mention of what 
was accomplished by these Jewish physicians, whose 
names we have scarcely been able to more than cata 
logue, nor of the place they hold in their times. As 
the physicians of rulers, their influence for culture 
and the cultivation of science was extensive, and as 
a rule they stood for what was best and highest in 
education. The story of one of them, who is gen 
erally known in the Christian world at least, Mai- 
monides, given in some detail, may serve as a type 
of these Jewish physicians of the Middle Ages. He 
lived just before the flourishing period of university 
life in the thirteenth century brought about that 
wonderful development of medicine and surgery in 
the west of Europe that meant so much for the final 
centuries of the Middle Ages. His works influenced 
not a little the great thinkers and teachers whose 
own writings were to be the foundations of education 
for several centuries after their time. Maimonides 
was well known in the Western universities. 
Though his life had been mainly spent in the East, 
and he died there, there was scarcely a distinguished 
scholar of Europe who was not acquainted directly 


or indirectly with his works, and the greater the 
reputation of the scholar, as a rule, the more he 
knew of Maimonides, Moses JEgyptseus, as he was 
called, and the more frequently he referred to his 


The life of one of the great Jewish physicians, 
who has come to be known in history as Maimonides, 
is of such significance in medical biography that 
he deserves to have a separate sketch. Born in 
Spain, his life was lived in the East, where his con 
nection as royal physician with the great Sultan 
Saladin of Crusades fame made his influence 
widely felt. He is a type of the broadly educated 
man, conversant with the culture of his time and of 
the past, knowing much besides medicine, who has 
so often impressed himself deeply on medical prac 
tice. While the narrow specialists in each genera 
tion, the men who are quite sure that they are cur 
ing the special ills of men to which they devote 
themselves, have always felt that whatever of 
progress there was in any given time was due to 
them, they occupy but little space as a rule in the 
history of medicine. The men who loom large were 
the broad-minded, humanely sympathetic, deeply 
educated physicians, who treated men and their ills 
rather than their ills without due consideration of 
the individual, and who not only relieved the dis 
comfort of their patients and greatly lessened 
human suffering, and added to the sum of human 
happiness in their time, but also left precious deeply 
significant lessons for succeeding generations of 



their profession. Hippocrates, Galen, Sydenham, 
Anenbragger, Morgagni, these are representatives 
of this great class, and Maimonides must be con 
sidered one of them. 

Moses Ben Maimum, whose Arabic name was Abu 
Amran Musa Ben Mairnurn Obaid Alia el-Cordovi, 
who was called by his Jewish compatriots Eamban 
or Eambam, was born at Cordova in Spain, on the 
30th of March in 1135 or 1139, the year is in doubt. 
It might not seem of much import now after nearly 
eight centuries, but not a little ink is spilt over it 
yet by devoted biographers. 

We are rather prone to think in our time that the 
conditions in which men were born and reared before 
what we are pleased to call modern times, and, above 
all, in the Middle Ages, must have made a distinct 
handicap for their intellectual development. Most 
of us are quite sure that the conditions in medieval 
cities were eminently unsuited for the stimulation of 
the intellect, for incentive to art impulse, for up 
lift in the intellectual life, or for any such broad 
interest in what has been so well called the human 
ities the humanizing things that lift us above ani 
mal necessities as would make for genuinely lib 
eral education. "We are likely to be set in the 
opinion that the environment of the growing youth 
of an old-time city, especially so early as the middle 
of the twelfth century, was poor and sordid. The 
cares of the citizens are presumed to have been 
mainly for material concerns, and, indeed, mostly 
for the wants of the body. They were only making 
a start on the way from barbarism to something like 
our glorious culmination of civilization. As " the 


heirs to all the ages in the foremost files of time 
we are necessarily far in advance of them, and we 
are only sorry that they did not have the oppor 
tunity to live to see our day and enjoy the benefits 
of the evolution of humanity that is taking place 
during the eight centuries that have elapsed. 

As a matter of fact, there was much more of abid 
ing profound interest in real civilization in many a 
medieval city, much more general appreciation of 
art, much more breadth of intelligence and sym 
pathy with what we call the humanities, than in most 
of our large cities. The large city, as we know it, is 
eminently a discourager of breadth of intelligence. 
Specialism in the various phases of money-making 
obscures culture. Maimonides, born in Cordova, 
was brought up amid surroundings that teemed with 
incentives of every kind to the development of in 
telligence, of artistic taste, and everything that 
makes for cultivation of intellect rather than of in 
terest in merely material things. 

It is well said that it is hard to judge the Cor 
dova of old by its tawdry rains of to-day. The edu 
cated visitor still stands in awe and admiration 
of the great mosque which expressed the high cul 
tivation of the Moors of this time. It is a never- 
ending source of wonder to Americans. The city 
itself has many reminders of that fine era of Moorish 
culture and refinement of taste and of art ex 
pression, which made it in the best sense of the 
word a city beautiful. The Arab invaders had 
found a great prosperous country which had been 
the most cultured province of the Roman Empire, 
and on this foundation they made a marvellous de- 


velopment. " The banks of the Guadalquivir," 
says Mr. S. Lane-Poole in " The Moors in Spain " 
(London, 1887), " were bright with marble houses, 
mosques, and gardens, in which the rarest flowers 
and trees of other countries were carefully culti 
vated, and the Arabs introduced their system of ir 
rigation which the Spaniards both before and since 
have never equalled." The greatest beauty of the 
city, of course, had come, and some of it had gone, 
before Maimonides time. So much remains in spite 
of time and war, and many unfortunate influences, 
that we can have some idea how beautiful it must 
have been in his youth seven centuries ago, and 
how even more beautiful in the foretime. Of the 
great mosque writers of travel can scarcely say 
enough. Mr. Lane-Poole says: " Travellers stand 
amazed among the forest of columns which open out 
apparently endless vistas on all sides. The por 
phyry, jasper, and marbles are still in their places ; 
the splendid glass mosaics, which artists from By 
zantium came to make, still sparkle like jewels in 
the walls ; the daring architecture of the sanctuary, 
with its fantastic crossed arches, is still as imposing 
as ever ; the courtyard is still leafy with the orange 
trees that prolong the vistas of columns. As one 
stands before the loveliness of the great mosque, the 
thought goes back to the days of the glories of Cor 
dova, the palmy days of the Great Khalif, which 
will never return." 

Of all the countries in which the Jews all down 
the centuries have lived there is probably none of 
which they have been more loud in praise than 
Spain. Their poets sang of it as if it were their 


own country; for centuries the people were happier 
here than probably they have been anywhere else 
for so long a period. Elsewhere in this book I have 
called attention to all that Spain meant in Europe 
during all the centuries from the beginning of the 
Roman Empire down to the end of the Middle Ages. 
Maimonides was fortunate in his birthplace, then, 
and while circumstances compelled the family to 
move away, this change did not come until a good 
effect had been produced on the mind of the grow 
ing youth. Even when persecution came, Maimon 
ides clung to Spain with a tenacity born of deep 
affection and emphasized by admiration for all 
that she was and had been. Cordova was the jewel 
of the Spain of this time, and though much less 
than she had been in the long preceding time, when 
she was the birthplace of Lucan and the two Senecas, 
or even than what she had been in Abd-er-Rahman s 
days, or when she was the birthplace of Averroes, 
still she remained wonderfully beautiful and at 
tractive, winning and holding the affections of men. 
Maimonides father, Maimum Ben Joseph, was a 
member of the Rabbinical College of Cordova, and 
famous for his knowledge of the Talmud. There 
are some writings of his on mathematics and 
astronomy extant. He directed the education of his 
son, who, like many another distinguished scholar 
in later life, seems to have exhibited very little 
talent in his early years. There is no rule in the 
matter. Precocity often disappoints. Genius is 
often dull in childhood, but there are exceptions that 
prove both rules. The basis of education in Spain 
at that time among the Jews was the Bible, the 


Talmud, mathematics, and astronomy, a good 
rounded education in literature, the basis of law, 
and some exact physical science. After his prelim 
inary education at home Maimonides studied the 
natural sciences and medicine with Moorish teach 
ers. Nature-study, in spite of frequent expressions 
that declare it new in modern times, is as old as 
man. He also received a grounding in philosophy 
as a preparation for his scientific studies. At the 
age of twenty-three he began the composition of a 
commentary on the Talmud, which he continued to 
work at on his journeys in Spain and in Egypt. 
This is considered to be one of the most important 
of this class of works extant, though, almost need 
less to say, similar writings are very numerous. 

In the light of wanderings in philosophy during 
the centuries since, it is rather interesting to quote 
from that work the end of man as this Jewish 
philosopher of the middle of the twelfth century 
saw it. Eecent teleological tendencies in biology 
add to the interest of his views. According to 
Maimonides, " Man is the end of the whole creation, 
and we have only to look to him for the reason for 
its existence. Every object shows the end for 
which it was created. The palm-trees are there to 
provide dates ; the spider to spin her webs. All the 
properties of an animal or a plant are directed so 
as to enable it to reach its purpose in life. What is 
the purpose of man? It cannot lie alone in eating 
and drinking or yielding to passion, nor in the 
building of cities and the ruling of others, since 
these objects lie outside of him, and do not touch his 
essential being. Such material striving he has in 


common with the animal. A man is lifted from a 
lower to a higher condition by his reason. Only 
through his reason is he placed above the animals. 
He is the only reasonable animal. His reason en 
ables him to understand all things, especially the 
Unity of G-od, and all knowledge and science serve 
only to direct man to the knowledge of God. Pas 
sions are to be subdued, since the man who yields 
to passion subjects his spirit to his body, and does 
not reveal in himself the divine power which in him 
lies in his reason, but is swallowed up in the ocean 
of matter." 

Not long after Maimonides passed his twentieth 
year the family, consisting of the father and his 
two sons, Moses and David, and a daughter, moved 
from Cordova to Fez, compelled by Jewish persecu 
tions. Here it is said that they had to submit to 
wearing the mask of Islam in order to lead a peace 
ful existence. This has been doubted, however, and 
his whole life is in flagrant contradiction with any 
such even apparent apostasy from the faith of his 
fathers. Father and son took advantage of the 
opportunity of intercourse with Moorish physicians 
and philosophers to increase their store of knowl 
edge, but could not be content in the political and 
religious conditions in which they were compelled 
to live. About 1155, then, they went to Jerusalem, 
but found conditions even more intolerable there, 
and turned back to Egypt, where they settled down 
in Old Cairo. In 1166 the father died, and after 
this we learn that the sons made a livelihood, and 
even laid the foundation of a fortune, by carrying 
on a jewelry trade. Moses still devoted most of his 


time to study, while his brother did most of the 
business, but the brother was lost in the Indian 
Ocean, and with him went not only a large sum of 
his own money, but also much that had been en 
trusted to him by others. Maunonides undertook 
to pay off these debts and at the same time had to 
meet the necessities not only of himself and sister, 
but also of the family of his dead brother. It was 
then that he took up the practice of medicine and 
succeeded in making a great name and reputation 
for himself. He continued to write, however, and 
completed his commentary on the Talmud. 

About the age of fifty Maimonides, as seems to be 
true of a good many men who live to old age, be 
came rather discouraged and despondent about him 
self. He refers to himself in his letters and 
writings rather frequently as an old and ailing man. 
He had nearly twenty years of active life ahead of 
him, but he had the persuasion that comes to many 
that he was probably destined to an early death. 
His son was born shortly after this time, and that 
seems to have had not a little to do with brightening 
his life. While in Egypt Maimonides married the 
sister of one of the royal secretaries, who, in turn, 
wedded Maimonides sister. Maimonides took on 
himself the education of his son, who also became 
a physician, though his father was not to have the 
satisfaction of watching his success in the practice 
of his chosen profession. This son, Abraham, be 
came the physician of Malie Alkamen, the brother 
of Saladin, and, besides, was a physician to the hos 
pital at Cairo. His son, David, the grandson of 
Maimonides, practised medicine also at Cairo till 


1300. He in turn left two sons, Abraham and Solo 
mon, who achieved reputation in the chosen pro 
fession of their great-grandfather. 

Maimonides, after the birth of his son, became 
one of the busiest of practising physicians. Indeed, 
it is hard to understand how he had the time to do 
any writing in his busy life. Still less can we un 
derstand his time for teaching. He was the physi 
cian to Saladin, whose relations with Richard Co2tir 
de Lion have made him known to English-speaking 
people. Every morning, as the Court physician, 
Mainiomcles went to the palace, situated half a mile 
away from his dwelling, and if any of the many of 
ficials and dependents that then, as now, were at 
Oriental courts, were ill, he stayed there for some 
time. As a rule he could only get back to his own 
home in the afternoon, and then he was, as he says 
himself, " almost dying with hunger." Knowing 
the scantiness of the Oriental breakfast, we are not 
surprised. There he found his waiting-room full 
of patients, " Jews and Mohammedans, prominent 
and unimportant, friends and enemies," he says 
himself, " a varied crowd, who are looking for my 
medical advice. There is scarcely time for me to 
get down from my carriage and wash myself and 
eat a little, and then until night I am constantly 
occupied, so that, from sheer exhaustion, I must lie 
down. Only on the Sabbath day have I the time to 
occupy myself with my own people and my studies, 
and so the day is away from me." What a picture 
it is of the busy medical teacher at all times in the 
world s history, yet it must not be forgotten that 
it is from these busy men that we have derived our 


most precious lessons in caring for patients rather 
than disease, in the art of medicine rather than med 
ical science and their practical lessons have been 
valuable long after the fine-spun theories of the 
scientist that took so long to elaborate have been 
placed definitely in the lumber room. 

His reputation as a writer on medical topics is 
not as great as that which has been accorded him 
for his writings on philosophy and in Talmudic 
literature, but he well deserves a place among the 
great practical masters of medicine, as well as high 
rank among the physicians of his time. There is 
little that is original in his writing, but his thorough 
going common sense, his wide knowledge, and his 
discriminating, eclectic faculty make his writings 
of special value. As might have been expected, the 
Aphorisms of Hippocrates attracted his attention, 
and, besides, he wrote a series of aphorisms of his 
own. The most interesting of his writings, how 
ever, is a series of letters on dietetics written for 
the son of his patron Saladin. The young prince 
seems to have suffered from one of the neurotic con 
ditions that so often develop in those who have their 
lives all planned for them, and little incentive to do 
things for themselves. The main portion of his 
complaints centred, as in the case of many another 
individual of leisure, in disturbances of digestion. 
Besides, he suffered from constipation and feelings 
of depression. Doubtless, like many a young per 
son of the modern time, he was quite sure that these 
symptoms portended some insidious organic ail 
ment that would surely bring an early death. When 
fathers, having done all that there is to do, just ex- 


pect their sons to enjoy the fruits of the paternal 
accomplishments, conditions of this kind very often 
develop, unless the young man proceeds to occupy 
himself with even more dangerous distractions than 
he finds in unending thought about his own feelings. 
The rules of life and health that Maimonides laid 
down in these letters have become part of our pop 
ular medical tradition. Probably more of the 
ordinarily current maxims as to health have been 
derived from them than would possibly be suspected 
by anyone not familiar with them. In various 
forms his rules have been published a number of 
times. A good idea of them can be obtained from 
the following compendium of them, which I ab 
breviate from a biographical sketch of Maimonides 
by Dr. Oppler, which appeared in the " Deutsches 
Archiv fiir Geschichte der Medizin und Medicinische 
Geographic " (Bd. 2, Leipzig, 1879). 

1. Man is bound to lead a life pleasing to God if 
he wants to have a healthy body, and he must hold 
himself far from everything that can hurt his health 
and accustom himself to whatever renews his 
strength. He should eat ?nd drink only when hungry 
and thirsty and should be particularly careful of the 
regular evacuation of his bowels and of his bladder. 
He must not delay either of these operations, but as 
far as possible satisfy the inclination at once. 

2. A man must not overload his stomach but 
be content always with something less than is neces 
sary to make him feel quite satisfied. He should not 
drink much during the meal and only of water and 
wine mixed, taking somewhat more after digestion 
has begun and after digestion is completed, in mod 
eration according to his needs. Before a man sits 
down to table he should note whether he has any 


tendency to evacuation and should make the body 
warm by movement and activity. After this exercise 
he should rest a little before taking food. It is very 
beneficial after work to take a bath and then the 

3. Food should be taken always in the sitting 
position. There should be no riding nor walking, nor 
movements of the body until digestion is finished. 
The man who takes a walk or any strenuous occu 
pation immediately after eating subjects himself to 
serious dangers of disease. 

4. Day and night should be divided into twenty- 
four hours. Men should sleep for eight hours, and 
so arrange their sleep that the end of it comes with 
the dawn, so that from the beginning of sleep until 
sunrise there should be an eight-hour interval. We 
should all leave our beds about the time that the sun 

5. During sleep a man should lie neither on his 
face nor on his back but on his side, the beginning 
of the night on his left and at the end on his right. 
He should not go to sleep for three or four hours 
after eating and should not sleep during the day. 

6. Fruits that are laxative, as grapes, figs, 
melons, gourds, should be taken only before meal 
time and not mixed with other food. It would be 
better to let these get into the abdominal organs 
and then take other food. 

7. Eat what is easily digestible before what is 
difficult of digestion. The flesL of birds before beef 
and the flesh of calves before that of cows and steers. 
(Birds were then thought more digestible than other 
flesh; we have reversed the ruling. The note shows 
how light and digestible their flesh was considered 
and the reason therefor.) 

8. In summer eat cooling food, acids, and no 
spices. In winter, on the contrary, eat warming 
foods, rich in spices, mustard, and other heating sub- 


stances. In cold and warm climates one should eat 
according to the climatic conditions. 

9. There are certain harmful foods that should 
be avoided. Large salt fish, old cheese, old pickled 
meat, young new wine, evil-smelling and bitter foods 
are often poisonous. There are also some which are 
less harmful, but are not to be recommended as ordi 
nary nutritive materials. Large fish, cheese, milk 
more than twenty-four hours after milking, the flesh 
of old oxen, beans, peas, unleavened bread, sauer 
kraut, onions, radishes and the like. These are to be 
taken only in small quantities and only in the winter 
time and they should be avoided in the summer. 
Beans and lentils are to be recommended neither in 
winter nor summer. 

10. As a rule one should avoid the eating of tree 
fruits, or not eat much of them, especially when 
they are dry and even less when they are green. If 
they are unripe they may cause serious damage. Jo- 
hannesbrod is very harmful at all times, as are also 
all the sour fruits, and only small amounts of them 
should be eaten in summer or in warm countries. 

11. The fruits that are to be recommended dry 
as well as fresh, are figs, grapes, and almonds. 
These may be eaten as one has the appetite for them, 
but one should not accustom himself to eat them 
much, though they are healthier than all other fruits. 

12. Honey and wine are not good for children, 
though they are beneficial for older people, especially 
in winter. In summer one-third less of them should 
be eaten than in winter. 

13. Special care should be taken to have regular 
movements of the bowels that carry off the impuri 
ties of the body. It is an axiom in medicine, that 
so long as evacuations are absent, or difficult, or re 
quire strong efforts, the individual is liable to seri 
ous disease. Every medical means should be taken 
to overcome constipation in order to escape its dan- 


gers. For this purpose young people should be 
given salty food, materials that have been soaked in 
olive oil, salt itself, or certain vegetable soups with 
olive oil and salt. Older people should take honey 
mixed with warm water early in the morning and 
four hours later should take their breakfast. This 
proceeding should be followed up from one to four 
days until the constipation is overcome. 

14. Another axiom of medicine is that so long as 
a man is able to be active and vigorous, does not 
eat until he is over-full, and does not suffer from 
constipation, he is not liable to disease. Even such 
men, however, are much safer if they do not take 
food that may disagree with them. 

15. Whoever gives himself up to inactivity, or 
puts off evacuations of the bowels, or suffers from 
constipation, will be sure to suffer from many dis 
eases and will see his strength disappear even should 
he eat the best food in the world and make use of all 
the remedies that physicians have. Immoderate eat 
ing is a poison for men and the cause of many dis 
eases which attack them. Most diseases come from 
either eating too much or partaking of unsuitable 
food. That was what Solomon meant with his 
proverb : l He who puts a guard over his mouth and 
his tongue protects himself from many evils," that 
is to say, whoever protects his mouth from the over 
indulgence in food and his tongue from unsuitable 
speech protects himself from many evils. 

16. Every week at least a man should take a 
warm bath. One should not bathe when hungry, nor 
after eating until the food is digested, and bathe the 
whole body in warm but not too hot water and the 
head in hot water. Afterwards the body should be 
washed in lukewarm and cool water until finally cold 
water is used. One should pour neither cold nor 
even lukewarm water on the head, nor bathe in cold 
water in the winter time, nor when the body is 


tired and in perspiration. At such times the bath 
should be put off for a while. 

17. As soon as one leaves the bath one should 
cover oneself, and especially cover the head, so that 
no draught may strike it. Even in summer, care 
must be taken to observe this rule. After this one 
should rest for a while until the heat of the body 
passes off and then should go to table. If one could 
sleep a little just before a meal it is often very bene 
ficial. Neither during the bath nor immediately after 
it should cold water be drunk, and if there is an 
inappeasable thirst a little wine and water or water 
and honey should be taken. In winter it is beneficial 
to rub the body with oil after the bath. 

18. Venesection should not be practised fre 
quently, for it is only meant for serious illness. It 
should not be permitted in winter or summer, nor 
during the months of April or September (the " r 
months). After passing his fiftieth year an indi 
vidual should abstain from venesection. Venesec 
tion should not be practised on the day when one 
takes a bath or goes on a journey or returns from it. 
On the day when it is practised less than usual 
should be eaten and drunk, and the patient should 
give himself to rest, undertake no work nor bother 
some occupation, and take no walk. 

19. Whoever observes these rules of life faith 
fully I guarantee him a long life without disease. 
He shall reach a good old age, and when he comes 
to die will not need a physician. His body will re 
main always strong and healthy, unless of course 
he has been born with a weak nature, or has had an 
unfortunate bringing up, or should be attacked by 
epidemic disease or by famine. 

20. Only the healthy should keep these rules. 
Whoever is ill or a sufferer from any injuries, or 
has lost his health through bad habits, for him there 
are special rules for each disease, only to be found 


in the medical books. Let it be remembered that 
every change in a life habit is the beginning of an 

21. If no physician can be secured, then ailing 
people may nse these rules as well as the healthy. 

These rules are, of course, full of the common 
sense of medicine that endures at all times. For 
the tropical climate of the Eastern countries they 
probably represent as good advice as could be given 
even at the present time. "With them before us it is 
not surprising to find that on other subjects Mai- 
monides was just as sensible. Perhaps in nothing is 
this more striking than in his complete rejection of 
astrology. Considering how long astrology, in the 
sense of the doctrine of the stars influencing human 
health and destinies, had dominated men s minds, 
and how universal was the acceptance of it, Mai- 
monides strong expressions show how much genius 
lifts itself above the popular persuasions of its 
time, even among the educated, and how much it 
anticipates subsequent knowledge. 

It is well to remind ourselves that as late as the 
middle of the eighteenth century Mesmer s thesis 
on " The Influence of the Stars on Human Constitu 
tions " was accepted by the faculty of the University 
of Vienna as a satisfactory evidence not only of his 
knowledge of medicine, but of his power to reason 
about it. At the end of the twelfth century Maimon- 
ides was trying to argue it out of existence on the 
best possible grounds. " Know, my masters," he 
writes, " that no man should believe anything that 
is not attested by one of these three sanctions : ra 
tional proof as in mathematical science, the percep- 


tion of the senses, or traditions from the prophets 
and learned men." His biographer in the mono 
graph " Maimonides," published by the Jewish 
Publication Society of America, 1 expresses his 
further views on the subject in compendious form, 
and then gives his final conclusion as follows : 

" Works on astrology are the product of fools, 
who mistook vanity for wisdom. Men are inclined 
to believe whatever is written in a book, especially 
if the book be ancient; and in olden times disaster 
befell Israel because men devoted themselves to such 
idolatry instead of practising the arts of martial de 
fence and government. He says, that he had him 
self studied every extant astrological treatise, and 
had convinced himself that none deserved to be called 
scientific. Maimonides then proceeds to distinguish 
between astrology and astronomy, in the latter of 
which lies true and necessary wisdom. He ridicules 
the supposition that the fate of man could be de 
pendent on the constellations, and urges that such 
a theory robs life of purpose, and makes man a 
slave of destiny. It is true, he concludes, that 
you may find strange utterances in the Eabbinical 
literature which imply a belief in the potency of the 
stars at a man s nativity, but no one is justified in 
surrendering his own rational opinions because this 
or that sage erred, or because an allegorical remark 
is expressed literally. A man must never cast his 
own judgment behind him ; the eyes are set in front, 
not in the back. " 

While Maimonides could be so positive in his 
opinions with regard to a subject on which he felt 
competent to say something, he was extremely mod- 

1 " Maimonides," by Dcivid Yellin and Israel Abrahams, Philadelphia 


est with regard to many of the great problems of 
medicine. He often uses the expression in his 
"writings, " I do not see how to explain this matter." 
He quotes with approval from a Eabbi of old who 
had counselled his students, " teach thy tongue to 
say, I do not know. In this, of course, he has given 
the best possible evidence of his largeness of mind 
and his capacity for making advance in knowledge. 
It is when men are ready to say, " I do not know," 
that progress becomes possible. It is very easy to 
rest in a conscious or unconscious pretence of knowl 
edge that obscures the real question at issue. A great 
thinker, who lived in the century in which Maimon- 
ides died, Roger Bacon, set down as one of the 
four principal obstacles to advance in knowledge 
indeed, as the one of the four that hampered intel 
lectual progress the most, the fact that men feared 
to say, " I do not know." 

One of the most interesting features of Maimon- 
ides career for the modern time is the influence that 
his writings exerted over the rising intellectual life 
of Europe within a half century after his death. 
Most people would be rather inclined to think that 
this Jewish author of the East would have very 
little influence over the thinkers and teachers of 
Europe within a generation after his death. He 
died in 1204, just at the beginning of one of the 
great productive centuries of humanity, perhaps 
one of the greatest of them all. In literature, in 
art, in architecture, in philosophy, and in educa 
tion, this century made wonderful strides. Two of 
its greatest teachers, Albertus Magnus and his 
pupil, Thomas Aquinas, quote from Moses JEgyp- 


taeus, the European name for Mairnonides at that 
time, and evidently knew his writings very well. 
Maimonides was for them an important connecting 
link with the world of old Greek thought. Others 
of the writers and teachers of this time, as William 
of Auvergne, and the two great Franciscans, Alex 
ander of Hales and Duns Scotus, were also in 
fluenced by Afaimonides. In a word, the educa 
tional world of that time was much more closely 
united than we might think, and it did not take 
long for a great writer s thoughts to make them 
selves felt several thousand miles away. Maimon- 
ides was, then, in his own time one of the world 
teachers, and, in a certain sense, he must always re 
main that, as representing a special development of 
what is best in human nature. 


In order to understand the place of the Arabs in 
medicine and in science, a few words as to the rise 
of this people to political power, and then to the cul 
tivation of literature and of science, are necessary. 
We hear of the Arabs as hireling- soldiers fighting 
for others during the centuries just after Christ, 
and especially in connection with the story of the 
famous Queen Zenobia at Palmyra. After the de 
struction of this city we hear nothing more of them 
until the time of Mohammed. During these six and 
a half centuries there is little question of education 
of any kind among them except that at the end of 
the sixth century, the Persian King Chosroes I, 
who was much interested in medicine, encouraged 
the medical school in Djondisabour, in Arabistan, 
founded at the end of the fifth century by the Nes- 
torian Christians, who continued as the teachers 
there until it became one of the most important 
schools of the East. It was here that the first Arab 
physicians were trained, and here that the Chris 
tian physicians who practised medicine among the 
Arabs were educated. 

Among the Arabs themselves, before the time of 
Mohammed, there had been very little interest in 
medicine. Gurlt notes that even the physician of 
the Prophet himself was, according to tradition, a 



Christian. Mohammed s immediate successors were 
not interested in education, and their people mainly 
turned to Christian and Jewish physicians for 
whatever medical treatment they needed. When 
the Caliphs came to be rulers of the Mohammedan 
Empire, they took special pains to encourage the 
study of philosophy and medicine; though dissec 
tion was forbidden by the Koran, most of the other 
medical sciences, and especially botany and all the 
therapeutic arts, were seriously cultivated. 

Until the coming of Mohammed, the Arabs had 
been wandering tribes, getting some fame as hireling 
soldiers, but now, under the influence of a feeling 
of community in religion, and led by the military 
genius of some of Mohammed s successors, whose 
soldiers were inspired by the religious feelings of 
the sect, they made great conquests. The Moham 
medan Empire extended from India to Spain within 
a century after Mohammed s death. Carthage was 
taken and destroyed, Constantinople was threat 
ened. In 661, scarcely forty years after the hegira 
or flight of Mohammed, from which good Moham 
medans date their era, the capital was transferred 
from Medina to Damascus, to be transferred from 
here to Bagdad just about a century later, where it 
remained until the Mongols made an end of the 
Abbasside rulers about the middle of the thirteenth 
century. At the beginning the followers of Mo 
hammed were opposed to knowledge and education 
of all kinds. Mohammed himself had but little. 
According to tradition, he could not read or write. 
The story told with regard to the Caliph Omar and 
the great library of Alexandria, seems to have a 


foundation in reality, though such legends usually 
are not to be taken literally. Certainly it represents 
the traditional view as to the attitude of the earlier 
Moslem rulers to education. Omar was asked what 
should be done with the more than two million vol 
umes. He said that the books in it either agreed 
with the Koran, or they did not. If they agreed 
with it they were quite useless. If they did not, 
they were pernicious. In either case, they should 
be done away with, because there was an element of 
danger in them. Accordingly, the precious volumes 
that had been accumulating for nearly ten centuries, 
served, it is said, to heat the baths of Alexandria 
for some six months probably the most precious 
fuel ever, used. Fortunately for posterity, the edict 
was not quite as universal in its application as the 
story would indicate, and exceptions were made for 
books of science. 

In the course of their conquests, however, the 
Mohammedan Arabs captured the Greek cities of 
Asia Minor. They were brought closely in contact 
with Greek culture, Greek literature, and Greek 
thought. As has always been the case, captive 
Greece took its captors captive. What happened 
to the Eomans earlier came to pass also among the 
Arabs. Inspired by Greek philosophy, science, and 
literature, they became ardent devotees of science 
and the arts. While not inventing or discovering 
anything new, like the Eomans they carried on the 
old. Damascus, Basra, Bagdad, Bokhara, Samar- 
cand all became centres of culture and of educa 
tion. Large sums were paid for Greek manu 
scripts, and for translations from them. Under the 


famous Harun al-Kaschid, at the end of the eighth 
century, whose name is better known to us than that 
of any others, because of the stories of his wander 
ing by night among his people in order to see if 
justice were done, three hundred scholars were sent 
at the cost of the Caliph to the various parts of the 
world in order to bring back treasures of science, 
and especially of geography and medicine. It is an 
interesting historical reflection that the Japanese 
and Chinese are doing the same thing now. 

The Arabs were very much taken by the philoso 
phy of Aristotle, and it became the foundation of all 
their education. Greek thought, as always, inspired 
its students to higher things. Soon everywhere in 
the dominions of the Caliphs, philosophy, science, 
art, literature, and education flourished. Medicine 
was taken up with the other sciences and cultivated 
assiduously. Freind, in his " Historia Medicinae," 
says that the writings of the old Greeks which 
treated of medicine were saved from destruction 
with the other books at Alexandria, for the desire 
of health did not have less strength among the Arabs 
than among other nations. Since these books 
taught them how to preserve health, and were not 
otherwise contrary to the laws of the Prophet, that 
served to bring about their preservation. Freind 
also calls attention to the fact that grammars and 
books which treated of the science of language were 
likewise saved from destruction. Besides the 
library, the Arabs, after their conquest of Alex 
andria in the eighth century, came under the in 
fluence of the university still in existence there. 

In the West, in Spain, the Arabs enjoyed the 


same advantages as regards contact with culture 
and education as their conquest of the Eastern 
cities and Alexandria brought them in the East. 
While it is not generally realized, Spain was, as we 
have pointed out, the province of the Roman Em 
pire in the "West that advanced most in culture be 
fore the breaking up of the Empire. The Silver 
Age of Latin literature owes all of its geniuses to 
Spain. Lucan, the Senecas, Martial, Quintilian, 
are all Spaniards. Spain itself was a most flourish 
ing province, and under the Spanish Caesars, from 
the end of the first to about the end of the second 
century, increased rapidly in population. Spain 
was the leader in these prosperous times, and the 
tradition of culture maintained itself. When 
Spain became Christian the first great Christian 
poet, Prudentius, born about the middle of the 
fourth century, came from there. He has been 
called the Horace and Virgil of the Christians. 

The coming down of the barbarians from the 
North disturbed Spain s prosperity and the peace 
and culture of her inhabitants, but it should not be 
forgotten that the first medieval popularization of 
science, a sort of encyclopedia of knowledge, the 
first of its kind after that of Pliny in the classical 
period, came from St. Isidore of Seville, a Spanish 

There has been considerable tendency to insist 
that Spanish culture and intellectuality owe nearly 
all to the presence of the Moors in Spain. This can 
only be urged, however, by those who know nothing 
at all of the Spanish Caesars, the place of Spain in 
the history of the Eoman Empire, and the continu- 


ance of the culture that then reached a climax of 
expression during succeeding centuries. On the 
contrary, the Moors who came to Spain owe most 
of their tendency to devote themselves to culture 
and education to the state of affairs existent in 
Spain when they came. There is no doubt that 
they raised standards of education and of culture 
above the level to which they had sunk under the 
weight of the invading barbarians from the North, 
and Spain owes much to the wise ruling and devo 
tion to the intellectual life of her Moorish invaders. 
All the factors, however, must be taken together in. 
order to appreciate properly the conditions which 
developed under the Arabs in both the East and the 
West. The Arabs invented little that was new in 
science or philosophy; they merely carried on older 
traditions. It is for that that the modern time 
owes them a great debt of gratitude. 


The most distinguished of the Arabian physicians 
was the man whose rather lengthy Arabian name, 
beginning with Abu Bekr Mohammed, finished with 
el-Razi, and who has hence been usually referred 
to in the history of medicine as Rhazes. He was 
born about 850 at Raj, in the Province of Chorasan 
in Persia. He seems to have had a liberal early 
education in philosophy and in philology and litera 
ture. He did not take up medicine until later in 
life, and, according to tradition, supported himself 
as a singer until he was thirty years of age. Then 
he devoted himself to medical studies with the 


ardor and the success so often noted in those whose 
opportunity to study medicine has been delayed. 
His studies were made at Bagdad, where Ibn Zein 
el-Taberi was his teacher. He returned to his na 
tive town and was for some time the head of the 
hospital there. Later he was called by the Sultan to 
Bagdad to take charge of the renovated and en 
larged hospital of the capital. His medical career, 
then, is not unlike that of many another successful 
physician, especially of the modern time. At 
Bagdad he had abundant opportunities for study, 
and the ambition to make medicine as well as to 
make money and gain fame. 

His studies in science were all founded on Aris 
totle. Though he was called the Galen of his time, 
and looked up to the Greek physician as his master, 
even the authority of Galen did not override that of 
the Stagirite in his estimation. One of his apho 
risms is said to have been, If Galen and Aristotle 
are of one mind on a subject, then surely their 
opinion is true. When they differ, however, it is 
extremely difficult for the scholar to decide which 
opinion should be accepted." He drew many pupils 
to Bagdad, and, when one knows his teaching, this 
is not surprising. Some of his aphorisms are very 
practical. While the expressions just quoted with 
regard to Galen and Aristotle might seem to in 
dicate that Rhazes was absolutely wedded to author 
ity, there is another well-known maxim of his which 
shows how much he thought of the value of experi 
ence and observation. " Truth in medicine," he 
said, " is a goal which cannot be absolutely reached, 
and the art of healing, as it is described in books, 


is far beneath the practical experience of a skilful, 
thoughtful physician." Some of his other medical 
aphorisms are worth noting. "At the beginning of 
a disease choose such remedies as will not lessen 
the patient s strength." " When you can heal by 
diet, prescribe no other remedy, and, where simple 
remedies suffice, do not take complicated ones." 

Ehazes knew well the value of the influence of 
mind over body even in serious organic disease, and 
even though death seemed impending. One of his 
aphorisms is: " Physicians ought to console their 
patients even if the signs of impending death seem 
to be present. For the bodies of men are dependent 
on their spirits." He considered that the most 
valuable thing for the physician to do was to in 
crease the patient s natural vitality. Hence his ad 
vice: " In treating a patient, let your first thought 
be to strengthen his natural vitality. If you 
strengthen that, you remove ever so many ills with 
out more ado. If you weaken it, however, by the 
remedies that you use you always work harm." 
The simpler the means by which the patient s cure 
can be brought about, the better in his opinion. He 
insists again and again on diet rather than artificial 
remedies. "It is good for the physician that he 
should be able to cure disease by means of diet, if 
possible, rather than by means of medicine." An 
other of his aphorisms seems worth while quoting: 
" The patient who consults a great many physicians 
is likely to have a very confused state of mind." 

Some idea of Rhazes strenuous activity as a 
writer on medical subjects may be obtained from 
the fact that thirty-six of his works are still extant, 


and there are nearly two hundred others of which 
only the titles have been preserved. Some of these 
are doubtless the works of pupils and students of 
succeeding generations, published under his name 
to attract attention. His principal work is " Con- 
tinens," or " Comprehensor," which owes its title 
to the fact that it was meant to contain the whole 
practice of medicine and surgery. It includes 
references to the writings of all previous distin 
guished medical writers, from Hippocrates to 
Honein Ben Ishac, also known as Johannitius, a 
Christian Arabian physician, one of Khazes teach 
ers. The most frequently quoted of these authori 
ties are Galen, Oribasius, Aetius, and Paul of ^Egina. 
The work, however, is not made up entirely of quo 
tations, but contains many observations made by the 
author himself. Gurlt says that the foundation of 
the theoretic medicine of Khazes is the system of 
Galen, while in practice he seems to cling more to 
the aphorisms of Hippocrates. He has many prac 
tical points which show that he thought for himself. 
For instance, in wounds of the abdomen, if the in 
testines are extruded and cannot be replaced, he 
suggests the suspension of the patient by his hands 
and feet in a bath in order to facilitate their return. 
If they do not go back readily, compresses dipped in 
warm wine should be used. Cancer he declares to 
be almost incurable. He has much to say about the 
bites of animals and their tendency to be poisonous, 
knew rabies very well, and knew also that the 
bites of men might have similar serious conse 

It is impossible to give any adequate idea of the 


thoroughly practical character of Khazes medical 
writing in a few lines, but it may suffice to say that 
there is scarcely any feature of modern medicine 
and surgery that he does not touch, and oftener than 
not his touch is sure and rational and frequently 
much better than the advice of successors long after 
him in the same matters. An example or two will 
suffice to illustrate this. In the treatment of nasal 
polyps he says that whenever drug treatment of 
these is not successful, they should be removed with 
a snare made of hair. For fall of the uvula he sug 
gests gargles, but when these fail he advises re 
section and cauterization. Among the affections of 
the tongue he numbers abscess, fissure, ulcer, can 
cer, ranula, shortening of the ligaments, hypertro 
phy, erythema of the mucous membrane, and in 
flammatory swelling. In general his treatment of 
the upper respiratory tract is much farther ad 
vanced than we might think possible at this time. 
He advises tracheotomy whenever there is great dif 
ficulty of respiration, and describes how it should 
be done. After the dyspnea has passed the edges 
of the wound should be brought together with 
sutures. It is not surprising, then, to find that the 
treatment of fractures and luxations is eminently 
practical, and, indeed, on any subject that he touches 
he throws practical light. 

In the introduction to his edition of the works of 
Ambroise Pare, Malgaigne says that the first refer 
ence to a metal band in connection with trusses is 
to be found in Ehazes. Hernia was, of course, one 
of the serious ailments that, because of its super 
ficial character, was rather well understood, and so 


it is not surprising to find that much of our modern 
treatment of it was anticipated. The manipulations 
for taxis, the use of a warm bath for the relaxation 
of the patient by means of heat and by putting the 
head and feet higher than the abdomen while in the 
bath, and the employment of various kinds of trusses 
to prevent strangulation of the hernia recur over 
and over again, in the authors of the Middle Ages. 
Many of the suggestions are to be found in the early 
Greek authors, but subsequent writers give a cer 
tain personal expression to them which shows how 
much they had learned by personal observation in 
the employment of various methods. 

Pagel, in Puschmann s " Handbook of the His 
tory of Medicine," declares that Rhazes most im 
portant work for pure medicine is his monograph on 
smallpox. Its principal value is due to the fact 
that, though he has consulted old authorities care 
fully, his discussion of the disease is founded al 
most entirely on his own experience. His descrip 
tion of the various stages of the disease, of the forms 
of the eruption, and of the differential diagnosis, is 
very accurate. He compares the course of the fever 
with that of other fevers, and brings out exactly 
what constitutes the disease. His suggestions as 
to prognosis are excellent. Those cases, he de 
clares, are particularly serious in which the erup 
tion takes on a dark, or greenish, or violet color. 
The prognosis is also unfavorable for those cases 
which, having considerable fever, have only a slight 
amount of rash. His treatment of the disease in 
young persons was by venesection and cool douches. 
Cold water and acid drinks should be administered 


freely, so that sweat and other excretions may carry 
off poisonous materials. Care must be taken to 
watch the pulse, the breathing, the appearance of 
the feet, the evacuations from the bowels, and to 
modify therapy in accordance with these indications. 
The eruption is to be encouraged by external warmth 
and special care must be taken with regard to com 
plications in the eyes, the ears, the nose, the mouth, 
and the pharynx. 

A fact that will, perhaps, give the best idea to 
modern readers of the place of Rhazes in the his 
tory of medicine is that Vesalius considered it worth 
his while to make a translation of his principal work. 
Unfortunately that translation has not come down 
to us. When Vesalius, pestered by the con 
troversies that had come upon him because of his 
venturing to make his observations for himself, ac 
cepted the post of physician to the Ernperor Charles 
V, he burnt a number of his manuscripts. 
Among these were his translation of Bhazes and 
some annotations on Galen, which, as he says him 
self, had grown into a huge volume. The Galenists 
were bitterly decrying his refusal to accept Galen 
on many points, and both of these works would have 
added fuel to the flame of controversy. He deemed 
it wiser, then, not to give any further opportunities 
for rancorous criticism, and, feeling presumably 
that in his new and important post it was not worth 
while to bother further over the matter, he burnt 
them. He tells the reason in his letters to Joachin 
Roelant : When I was about to leave Italy to go 
to Court, since a number of the physicians whom 
you know had made the worst kind of censure of 


my books, both to the Emperor himself, and to other 
rulers, I burned all the manuscripts that were left, 
although I had never suffered a moment under the 
displeasure of the Emperor because of these com 
plaints, and in spite of the fact that a number of 
friends who were present urged me not to destroy 

Vesalius translation of Khazes was probably un 
dertaken because he recognized in him a kindred 
spirit of original investigation and inquiry, whose 
work, because it was many centuries old, would 
command the weight of an authority and at the same 
time help in the controversy over Galenic questions. 
This, of itself, would be quite enough to make the 
reputation of Khazes, even if we did not know from 
the writings themselves and from the admiration of 
many distinguished men as well as the incentive that 
his works have so often proved to original ob 
servation, that he is an important link in the chain 
of observers in medicine, who, though we would 
naturally expect them to be so frequent, are really 
so rare. 


Khazes lived well on into the tenth century. His 
successor in prestige, though not his serious rival, 
was Ali Ben el-Abbas, usually spoken of in medical 
literature as Ali Abbas, a distinguished Arabian 
physician who died near the end of the tenth cen 
tury. He wrote a book on medicine which, because 
of its dedication to the Sultan, to whom he was body- 
physician, is known as the " Liber Regius," or 


" Royal Book of Medicine." This became the lead 
ing text-book of medicine for the Arabs until re 
placed by the " Canon of Avicenna " some two cen 
turies later. The " Liber Regius " was an ex 
tremely practical work and, like most of the Arabian 
books of the early times, is simple and direct, quite 
without many of the objectionable features that de 
veloped later in Arabian medicine. It is valuable 
mainly for its contributions to diet and the fact 
that AH Abbas tested many of his medicines on ail 
ing animals before applying them to men. Of 
course, it owes much to earlier writers on medicine, 
and especially to Paul of JEgina. 

An example of its practical value is to be found 
in his description of the treatment of a wound of 
the brachial artery, when, as happened often in 
venesection from the median basilic vein, it was in 
jured through carelessness or inadvertence. If 
astringent or cauterizing methods do not stop the 
bleeding, the artery should be exposed, carefully 
isolated, tied in two places above and below the 
wound, and then cut across between them. He has 
many similar practical bits of technique. For in 
stance, in pulling a back tooth he recommends that 
the gums be incised so as to loosen them around 
the roots, and then the tooth itself may be drawn 
with a special forceps which he calls a molar forceps. 
In ascites he recommends that when other means 
fail an opening should be made three finger-breadths 
below the navel with a pointed phlebotomy knife, 
and a portion of the fluid allowed to evacuate itself. 
A tube should then be inserted, but closed. The 
next day more of the fluid should be allowed to 


come away, and then the tube removed and the ab 
domen wrapped with a firm bandage. 

It is easy to understand that AH Abbas book 
should have been popular, and the more we know 
of it the easier it is to explain why Constantino 
Africanus should have selected it for translation. 
It contains ten theoretic and ten practical books, and 
gives an excellent idea of the medical knowledge and 
medical practice of the time. Probably the fact 
that Constantine had translated it led to its early 
printing, so that we have an edition of it published 
at Venice in 1492, and another at Lyons in 1523. 
During the Middle Ages the book was often spoken 
of as " Eegalis Dispositio," the " Royal Disposi 
tion of Medicine." 


After Rhazes, the most important contributors to 
medical literature from among the Arabs, with the 
single exception of Avicenna, were born in Spain. 
They are Albucasis or Abulcasis, the surgeon; 
Avenzoar, the physician, and Averroes, the philo 
sophic theorist in medicine. Besides, it may be re 
called here that Maimonides, the great Jewish physi 
cian, was born and educated at Cordova, in Spain. 
It might very well be a surprise that these distin 
guished men among the Arabs should have flour 
ished in Spain, so far from the original seat of 
Arabian and Mohammedan dominion in the East, 
where, owing to conditions in the modern time, the 
English-speaking world particularly is not likely to 
assume that the environment was favorable for the 


development of science and philosophy. Anyone 
who recalls, however, the history of Spanish in 
tellectual influence in the Eoman Empire, as we 
have traced it at the beginning of this chapter, will 
appreciate how favorable conditions were in Spain 
for the fostering of intellectual development. With 
the disturbances that had come from political strife 
and the invasion of the barbarians in Italy, Spain 
had undoubtedly come to hold the primacy in the in 
tellectual life of Europe at the time when the Arabs 
took possession of the peninsula. 


The most important of the Arabian surgeons of 
the Middle Ages is Albueasis or Abulcasis, also 
Abulkasim, w r ho was born near Cordova, in Spain. 
The exact year of his birth is not known, but he 
flourished in the second half of the tenth century. 
He is said to have lived to the age of 101. The 
name of his principal work, which embraces the 
whole of medicine, is " Altasrif," or " Tesrif," 
which has been translated " The Miscellany." Most 
of what he has to say about medical matters is 
taken from Rhazes. His work on surgery, however, 
in three books, represents his special contribution 
to the medical sciences. It contains a number of il 
lustrations of instruments, and is the first illustrated 
medical book that has come to us. It was translated 
into Latin, and was studied very faithfully by all 
the surgeons of the Middle Ages. Guy de Chauliac 
has quoted Albucasis about two hundred times in 
his " Chirurgia Magna." Even as late as the be- 


ginning of the sixteenth century Fabricius de Ac- 
quapendente, the teacher of Harvey, confessed that 
he owed most to three great medical writers, Celsus 
(first century), Paul of ^Egina (seventh century), 
and Abulcasis (tenth century). 

Abulcasis insisted that for successful surgery a 
detailed knowledge of anatomy was, above all, neces 
sary. He said that the reason why surgery had 
declined in his day was that physicians did not 
know their anatomy. The art of medicine, he added 
further, required much time. Unfortunately, to 
quote Hippocrates, there are many who are physi 
cians in name only, and not in fact, especially in 
what regards surgery. He gives some examples of 
surgical mistakes made by his professional brethren 
that were particularly called to his attention. They 
are the perennially familiar instances of ignorance 
causing death because surgeons were tempted to 
operate too extensively. 

His description of the procedure necessary to 
stop an artery from bleeding is an interesting ex 
ample of his method of teaching the practical tech 
nique of surgery. Apply the finger promptly upon 
the opening of the vessel and press until the blood 
is arrested. Having heated a cautery of the ap 
propriate size, take the finger away rapidly and 
touch the cautery at once to the end of the artery 
until the blood stops. If the spurting blood should 
cool the cautery, take another. There should be 
several ready for the purpose. Take care, he says, 
not to cauterize the nerves in the neighborhood, for 
this will add a new ailment to the patient s affec 
tion. There are only four ways of arresting arterial 


hemorrhage. First, by cautery ; second, by division 
of the artery, when that is not complete for then 
the extremities contract and the blood clots or by 
a ligature, or by the application of substances which 
arrest blood flow, aided by a compressive bandage. 
Other means are inefficient, and seldom and, at most, 
accidentally successful. His instruction for first 
aid to the injured in case of hemorrhage in the ab 
sence of the physician, is to apply pressure directly 
upon the wound itself. 

The development of the surgical specialties among 
the Arabs is particularly interesting. Abulcasis 
has much to say about nasal polyps. He divided 
them into three classes: (1) cancerous, (2) those 
with a number of feet, and (3) those that are soft 
and not living, these latter, he says, are neither 
malignant nor difficult to treat. He recommends 
the use of a hook for their removal, or a snare for 
those that cannot be removed with that instrument. 
His instructions for the removal of objects from the 
external ear are interestingly practical. He ad 
vises the use of bird lime on the end of a sound to 
which objects will cling, or, where they are smaller, 
suction through a silver or copper canula. Hooks 
and pincettes are also suggested. Insects should be 
removed with a hook, or with a canula, or, having 
been killed by warm oil, removed by means of a 
syringe. Some of his observations with regard to 
genito-urinary surgery are quite as interesting. He 
even treated congenital anomalies. He suggests cut 
ting of the meatus when narrowed, dilatation of 
strictures with lead sounds, and even suggests plans 
of operations to improve the condition in hypo- 


spadias. He gives the signs for differentiation be 
tween epitheliomata and condylomata, and distin 
guishes various forms of ulceration of the penis. 

Abulcasis discusses varicose veins in very much 
the same spirit as a modern surgeon does. They 
occur particularly in people who work much on 
their feet, and especially who have to carry heavy 
burdens. They should not be operated on unless 
they produce great discomfort, and make it impos 
sible for the sufferer to make his living. They may 
be operated on by means of incision or extirpation. 
Incision consists of cutting the veins at two or three 
places when they have been made prominent by 
means of tight bandages around the limb. The blood 
should be allowed to flow freely out of the cut ends, 
and then a bandage applied. For extirpation, the 
skin having been shaved beforehand, the vein should 
be made prominent, and then carefully laid bare. 
When freed from all adhesions, it should be lifted 
out on a hook, and either completely extirpated or 
several rather long pieces removed. He lays a good 
deal of stress on the necessity for freeing the vein 
thoroughly and lifting it well out of tissues before 
incising it. In old cases special care must be taken 
not to tear the vein. 

Minute details of technique are often found in 
these old authors. Abulcasis, for instance, treats of 
adherent fingers with up-to-date completeness. They 
can occur either congenitally or from injury, as, for 
instance, burning. They should be separated, and 
then separation maintained .by means of bandages 
or by the insertion between them of a thin lead plate, 
which prevents their readhesion. Adhesions of the 


fingers with the palm of the hand, which Abulcasis 
has also seen, should be treated the same way. 

At times there is surprise at finding some rare 
lesion treated with modern technique, and a hint 
at least of our modern apparatus. Fracture of the 
pubic arch, for instance, is described in Abulcasis 
quite as if he had had definite experience with it. 
When this occurs in a woman, the reposition of 
the bone is often greatly facilitated by a cotton 
tampon in the vagina. This tampon must be re 
moved at every urination. There is another way, 
however, of better securing the same purpose of 
counterpressure. One may take a sheep s bladder 
into the orifice of which a tube is fastened. One 
should introduce the bladder into the vagina, and 
then blow strongly through the tube, until the blad 
der becomes swollen and fills up the vaginal cavity. 
The fracture will, as a rule, then be readily re 
duced. Here is, of course, not alone the first hint 
of the colpeurynter, but a very practical form of 
the apparatus complete. Old-time physicians used 
the bladders of animals very generally for nearly 
all the medical purposes for which we now use rub 
ber bags. 


Undoubtedly the most important of Abulcasis 
contemporaries is the famous physician whose 
Arabic name, Ibn Sina, was transformed into Avi- 
cenna. He was born toward the end of the tenth 
century in the Persian province of Chorasan, at the 
height of Arabian influence, and is sometimes spoken 


of as the chief representative of Arabian medicine, 
of as much importance for it as Galen for later 
Greek medicine. His principal book is the so-called 
" Canon." It replaced the compendium " Con- 
tinens " of Ehazes, and, in the East, continued un 
til the end of the fifteenth century to be looked upon 
as the most complete and best system of medicine. 
Avicenna came to be better known in the West than 
any of the other Arabian writers, and his name car 
ried great weight with it. There are very few sub 
jects in medicine that did not receive suggestive, if 
not always adequate, treatment at the hands of this 
great Arabian medical thinker of the eleventh cen 
tury. He copied freely from his predecessors, but 
completed their work with his own observations and 
conclusions. One of his chapters is devoted to 
leprosy alone. He has definite information with re 
gard to bubonic plague and the filaria medinensis. 
Here and there one finds striking anticipations of 
what are supposed to be modern observations. 
Nothing was too small for his notice. One portion 
of the fourth book is on cosmetics, in which he 
treats the affections of the hair and of the nails. 
He has special chapters with regard to obesity, 
emaciation, and general constitutional conditions. 
His book, the " Antidotarium," is the foundation of 
our knowledge of the drug-giving of his time. 

Some idea of the popularity and influence of Avi 
cenna, five centuries after his time, can be readily 
derived from the number of commentaries on him 
issued during the Kenaissance period by the most 
distinguished medical scholars and writers of that 
time. Hyrtl, in his " Das Arabische und Hebraische 


in der Anatomie," quotes some of them, Bartholo- 
maeus de Varignana, Gentilis de Fulgineis, Jacobus 
de Partibus, Didacus Lopez, Jacobus de Forlivio, 
Ugo Senesis, Dinus de Garbo, Matthaeus de Gradi- 
bus, Nicolaus Leonicenus, Thaddaeus Florentinus, 
Galeatus de Sancta Sophia. A more complete list, 
with the titles of the books, may be found in Haller s 
" Bibliotheca Anatomica." For over three cen 
turies after the foundation of medical schools in 
Europe (and even after Mondino s book had been 
widely distributed), Avicenna was still in the hands 
of all those who had an enthusiasm for medical 


Another of the distinguished Arabian physicians 
was Avenzoar the transformation of his Arabic 
family name, Ibn-Zohr. He was probably born in 
Penaflor, not far from Seville. He died in Seville 
in 1162 at the age, it is said, of ninety-two years. 
He was the son of a physician descended from a 
family of scholars, jurists, physicians, and officials. 
He received the best education of the time not only 
in internal medicine, but in all the specialties, and 
must be counted among the greatest of the Spanish 
Arabian physicians. He was the teacher of Aver- 
roes, who always speaks of him with great respect. 
He is interesting as probably being the first to sug 
gest nutrition per rectum. A few words of his 
description show how well he knew the technique. 
His apparatus for the purpose consisted of the 
bladder of a goat or some similar animal structure, 


with a silver canula fastened into its neck, to be 
used about as we use a fountain syringe. Having 
first carefully washed out the rectum with cleansing 
and purifying clysters, he injected the nutriment- 
eggs, milk, and gruels into the gut. His idea was 
that the intestine would take this, and, as he said, 
suck it up, carrying it back to the stomach, where it 
would be digested. He was sure that he had seen 
his patients benefited by it. 

Some light on his studies of cases that would re 
quire such treatment may be obtained from what 
he has to say about the handling of a case of 
stricture of the esophagus. He says that this be 
gins with some discomfort, and then some difficulty 
of swallowing, which is gradually and continuously 
increased until finally there comes complete impos 
sibility of swallowing. It was in these cases that 
he suggested rectal alimentation, but he went 
farther than this, and treated the stricture of the 
esophagus itself. 

The first step in this treatment is that a canula 
of silver or tin should be inserted through the mouth 
and pushed down the throat till its head meets an 
obstruction, always being withdrawn when there is 
a vomiting movement, until it becomes engaged in 
the stricture. Then freshly milked milk, or gruel 
made from farina or barley, should be poured 
through it. He says that in these cases the patient 
might be put in a warm milk or gruel bath, since 
there are some physicians who believe that through 
the lower parts of the body, and also through the 
pores of the whole body, nutrition might be taken 
up. While he considers that this latter method 


should be tried in suitable cases, he has not very 
much faith in it, and says that the reasons urged 
for it are weak and rather frivolous. It is easy 
to understand that a man who has reached the place 
in medicine where he can recommend manipulative 
treatments of this kind, and discuss nutritional 
modes so rationally, knew his practical medicine 
well, and wrote of it judiciously. 


Among the distinguished contributors to medi 
cine at this time, though more a philosopher than a 
physician, is the famous Averroes, whose full Arabic 
name among his contemporaries was Abul-~Welid 
Mohammed Ben Ahmed Ibn Roschd el-Maliki. Like 
Avenzoar, of whom he was the intimate persona] 
friend, and Abulcasis and Maimonides, he was born 
in the south of Spain. He was in high favor with 
the King of Morocco and of Spain, El-Mansur Jacub, 
often known as Almansor, who made him one of his 
counsellors. His works are much more important 
for philosophy than for medicine, and his philo 
sophical writings gave him a place only second to 
that of Aristotle in the Western world during the 
Middle Ages. Averroism is still a subject of at least 
academic interest, and Kenan s monograph on it 
and its author was one of the popular books of the 
latter half of the nineteenth century in philosophic 
circles. In spite of his friendship with the Moorish 
King and with Avenzoar, he fell under the suspi 
cion of free thinking and was brought to trial with 
a number of personal friends, who occupied high. 


positions in the Moorish government. He escaped 
with his life, but only after great risks, and he was 
banished to a suburb of Cordova, in which only Jews 
were allowed to live. By personal influence he suc 
ceeded in securing the pardon of himself and 
friends, and then was summoned to the court of the 
son and successor of El-Mansur in Morocco. He 
died, not long after, in 1198. 

Altogether there are some thirty-three works of 
Averroes on philosophy and science. Only three 
of these are concerned with medicine. One is the 
" Colliget," so-called, containing seven books, on 
anatomy, physiology, pathology, diagnostics, ma- 
teria medica, hygiene, and therapy. Then there is 
a commentary on the " Cantica of Avicenna," and a 
tractate on the " Theriac." Averroes idea in writ 
ing about medicine was to apply his particular sys 
tem of philosophy to medical science. His intimate 
relations with other great physicians of the time, 
and in particular his close friendship with Avenzoar, 
enabled him to get abundant medical information in 
faultless order so far as knowledge then went, but 
his theoretic speculations, instead of helping medi 
cine, as he thought they would, and as philosophers 
have always been inclined to think as regards their 
theoretic contributions, were not only not of value, 
but to some extent at least hindered human progress 
by diverting men from the field of observation to 
that of speculation. It is interesting to realize that 
Averroes did in his time what Descartes did many 
centuries later, and many another brilliant thinker 
has done before and since. 



The fame of these great thinkers and writers in 
philosophy and in medicine came to be known not 
only through the distribution of their books long 
after their death, but during their lifetime, and in 
immediately subsequent generations, ardent seekers 
after knowledge, who were themselves afterwards 
to become famous by their teaching and writing, 
found their way into the Arabian dominions in 
order to take advantage of the educational oppor 
tunities afforded. These were better than they 
could secure at home in Christian countries, be 
cause the process of bringing culture and devotion 
to literature and science into the minds of the North 
ern nations, who had replaced the old Romans in 
Europe, was not yet completed. Bagdad and Cor 
dova were the two favorite places of educational 
pilgrimage. The names that are most familiar 
among the scholars in the Middle Ages in Europe 
are those of whom it is recorded that they made 
long journeys in order to get in touch with what 
the Arabs had preserved of the old Greek civiliza 
tion and culture. Among them are such men as 
Michael Scot or Scotus, Matthew Platearius, who 
was afterwards a great teacher at Salerno; Daniel 
Morley, Adelard of Bath, Egidius, otherwise known 
as Gilles de Corbeil; Rornoaldus, Gerbert of 
Auvergne, who later became Pope under the name 
of Sylvester II; Gerard of Cremona, and the best 
known of them all, at least in medicine, Constantine 
Africanus, whose wanderings, however, were prob- 


ably not limited to Arabian lands, but who seems 
also to have been in Hindustan. 

We are rather prone to think that this great spirit 
of going far afield for knowledge s sake is recent, 
or, at least, quite modern. As a matter of fact, 
one finds it everywhere in history. Long before 
Herodotus did his wanderings there were many vis 
itors who went to Egypt, and many more later who 
went to Crete, and many more a few centuries later 
who went to the shores of Asia Minor seeking for 
the precious pearl of knowledge, and sometimes find 
ing it without finding the even more precious pearl 
of wisdom, " whose worth is from the farthest 

To the Arabs we owe the foundation of a series 
of institutions for the higher learning, like those 
which had existed around them in Asia Minor and 
in Egypt at the time they made their conquests. 
Alexandria, Pergamos, Cos, Cnidos, Tarsus, and 
many other Eastern cities had had what we would 
call at least academies, and many of them deserved 
the name of universities. The Arabs continued the 
tradition in education that they found, and estab 
lished educational institutions which attracted wide 
attention. As we have said, the two most famous 
of these were at Bagdad and at Cordova. Mostan- 
ser, the predecessor of the last Caliph of the family 
of the Abbassides, built a handsome palace, in which 
the academy of Bagdad was housed. It is still in 
existence, and gives an excellent idea of the benefi 
cent interest of this monarch and of other of the 
Abbasside rulers in education. Its fate at the pres 
ent time is typical of the attitude of the Moham- 


medans towards education. Though the building is 
still standing, the institution of learning is no longer 
there. As Hyrtl remarks, it is not ideas that are 
exchanged in it now, but articles of commerce. It 
has become the chief office of the Turkish customs 
department in Bagdad. 

These institutions of the higher learning, founded 
by the Arabs, at first as rather strict imitations of 
the museums or academies of Egypt and Asia 
Minor, gradually changed their character under the 
Arabs. Their courses became much more formal, 
examinations became much more important. Schol 
arship was sought not so much for its own sake, as 
because it led to positions in the civil service, to the 
favor of princes, and, in general, to reputation and 
pecuniary reward. Formal testimonials proclaim 
ing education, signed by the academic authorities, 
were introduced and came to mean much. Lawyers 
could not practise without a license, physicians also 
required a license. These formalities were adopted 
by the Western medieval universities to a consid 
erable degree and have been perpetuated in the mod 
ern time. Undoubtedly they did much to hamper 
real education among the Arabs by setting in place 
of the satisfaction of learning for its own sake 
and the commendation of teachers the formal recog 
nition of a certain amount of work done as recog 
nized by the educational authorities. There was al 
ways a tendency among the Arabs to formulate and 
formalize, to over-systematize what they were at; 
to think that new knowledge could be obtained 
simply by speculating over what was already ac 
quired, and developing it. There are a number of 


comparisons between this and later periods of edu 
cation that might be suggested if comparisons were 
not odious. 

The influence of Arabian medicine on modern 
medicine can, perhaps, best be judged from the num 
ber of words in our modern nomenclature, which, 
though bearing Latin forms, often with suggestion 
of Greek origins, still are not derived from the old 
Latin or Greek authors, but represent Arabic terms 
translated into Latin during the Renaissance period. 
Hyrtl, without pretence of quoting them all, gives 
a list of these which is surprising in its compre 
hensiveness. For instance, the mediastinum, the 
sutura sagittalis, the scrobiculus cordis, the mar- 
supium cordis, the chambers of the heart, the velum 
palati, the trochanter, the rima glottidis, the fon- 
tanelles, the alas of the nose, all have their present 
names, not from original Latin expressions, but 
from the translation of Arabic terms. For all such 
words the Greeks and Romans have quite other ex 
pressions, in which the sense of our modern terms 
is not contained. This has given rise to many mis 
understandings, and to many attempts in the mod 
ern times to return to the classic terminology rather 
than preserve what in many cases are the barba 
risms introduced through the Arabic, but it is doubt 
ful whether any comprehensive reform in the matter 
can be effected, so strongly entrenched in medical 
usage have these terms now become. 

Freind, in his " History of Medicine," already 
cited, calls attention to the fact that the Arabs had 
an unfortunate tendency to change by addition or 
subtraction of their own views the authors that they 


studied, and wished to translate to others. This 
seems to have been true even of some of the most 
distinguished of them. Of course, the idea of pre 
serving an author s text untouched, and making it 
clear just where note and commentary came in, 
had not yet come to men s view, but quite apart from 
this the Arabs apparently often tried to gain ac 
ceptance for their own ideas by having them 
masquerade as the supposed ideas of favorite classic 

Another unfortunate tendency among the Arabs 
was their liking for the discussion of many trivial 
questions. Hyrtl, in his volume on " Arabian and 
Hebrew Words in Anatomy," 1 declares that it is 
almost incredible how earnestly some trivial ques 
tions in anatomy and physiology were discussed by 
the Arabs. He gives some examples. Why does 
no hair grow on the nose of men? Why does the 
stomach not lie behind the mouth? Why does the 
windpipe not lie behind the esophagus? Why are 
the breasts not on the abdomen? Why are not the 
calves on the anterior portion of the legs! Even 
such men as Ehazes and Avicenna discuss such 

It was this tendency of the Arabs that passed 
over to the Western Europeans with Arabian com 
mentaries on philosophy and science, and brought 
so many similar discussions in the scholastic period. 
These trivialities have usually been supposed to 
originate with the scholastics themselves, for they 
are not to be found in the Greek authors on whom 

1 Das Arabische und Hebraische in der Anatomic " Dr Joseph 
Hyrtl, Wien, 1879. 


the scholastics were writing commentaries, but they 
are typically Oriental in character, and it must be 
remembered that during the twelfth and early thir 
teenth centuries, at least, Greek philosophy found 
its way largely into Europe in Arab versions, and 
these characteristically Arabian additions of the 
discussion of curious trivial questions came with 
them and produced an imitative tendency among the 

As a rule the more careful has been the study of 
Arabian writers in the modern time, particularly 
by specialists, the clearer has it become that they 
lacked nearly all originality. Especially were they 
faulty in their observations; besides, they had a 
definite tendency to replace observation by theory, a 
fatal defect in medicine. The fine development of 
surgery that came at the end of the Arabian period 
of medicine in Europe could never have come from 
the Arabs themselves. Gurlt has brought this out 
particularly, but it will not be difficult to cite many 
other good authorities in support of this opinion. 

Hyrtl, in his " Thesis on the Rarer Old Anato 
mists," 1 says that " the Arabs paid very little at 
tention to anatomy, and, of course, because of the 
prohibition in the Koran, added nothing to it. What 
ever they knew they took from the Greeks, and espe 
cially Galen. Not only did they not add anything 
new to this, but they even lost sight of much that 
was important in the older authors. The Arabs 
were much more interested in physiology; they 
could study this by giving thought to it without soil- 

i"Anat. Antiq. Rariores," Vienna, 1835. 


ing their hands. They delighted in theory, rather 
than in observation." 

While we thus discuss the lack of originality and 
the tendency to over-refinement among the Arabian 
medical writers, it must not be thought that we 
would make little of what they accomplished. They 
not only preserved the old medical writers for us, 
but they kept alive practical medicine with the prin 
ciples of the great Greek thinkers as its basis. 
There are a large number of writers of Arabian 
medicine whose names have secured deservedly a 
high place in medical history. If this were a formal 
history of Arabian medicine, their careers and works 
would require discussion. For our purpose, how 
ever, it seems better to confine attention to a few 
of the most prominent Arabian writers on medi 
cine, because they will serve to illustrate how thor 
oughly practical were the Arabian physicians and 
how many medical problems that we are prone to 
think of as modern they occupied themselves with, 
solving them not infrequently nearly as we do in 
the modern time. 



The Medical School at Salerno, probably organized 
early in the tenth century, often spoken of as the 
darkest of the centuries, and reaching its highest 
point of influence at the end of the twelfth century, 
is of great interest in modern times for a number of 
reasons. First it brought about in the course of its 
development an organization of medical education, 
and an establishment of standards that were to be 
maintained whenever and wherever there was a true 
professional spirit down to our own time. They in 
sisted on a preliminary education of three years of 
college work, on at least four years of medical train 
ing, on special study for specialist s work, as in 
surgery, and on practical training with a physician 
or in a hospital before the student was allowed to 
practise for himself. At Salerno, too, the depart 
ment of women s diseases was given over to women 
professors, and we have the text-books of some of 
these women medical teachers. The license to prac 
tise given to women, however, seems to have been 
general and did not confine them merely to the care 
of women and children. We have records of a num 
ber of these licenses issued to women in the neigh 
borhood of Salerno. This subject of feminine med 
ical education at Salerno, because of its special inter 
est in our time, will have a chapter by itself. 



These are the special features of medical education 
in our own time that we are rather prone to think 
of as originating with ourselves and as being indices 
of that evolution of humanity and progress in man 
kind which are culminating in our era. It is rather 
interesting, then, to study just how these develop 
ments came about and what the genesis of this great 
school was. The books of its professors were widely 
read, not only in their own generation but for cen 
turies afterwards. With the invention of printing 
at the time of the Renaissance most of them were 
printed and exerted profound influence over the re 
vival of medicine which took place at that time. 
Salerno became the first of the universities in the 
modern sense of the word. Here there gathered 
round the medical school, first a preparatory depart 
ment representing modern college work, and then 
departments of theology and law, though this latter 
department particularly was never quite successful. 
The fact that the first university, that of Salerno, 
should have been organized round a medical school, 
the second, that of Bologna, around a law school, and 
the third, that of Paris, around a school of theology 
and philosophy, would seem to represent the ordi 
nary natural process of development in human inter 
ests. First man is interested in himself and in his 
health, then in his property, and finally in his rela 
tions to his fellow-man and to God. 

Though much work has been done on the subject 
in recent years, it is not easy to trace the origin of 
the medical school at Salerno. The difficulty is em 
phasized by the fact that even the earliest chron 
iclers whose accounts we have were not sure as to its 


origin, and even had some doubt about the age of the 
school. Alphanus, usually designated Alphanus I be 
cause there are several of the name, who is one of 
the earliest professors whose name and fame have 
come down to us, gives us the only definite detail as 
to the age of the school. He was a Benedictine 
monk, distinguished as a literary man, known both 
as poet and physician, who was afterwards raised to 
the Bishopric of Salerno. As a bishop he was one 
of the beneficent patrons, to whom the school owed 
much. He lived in the tenth century, and states that 
medicine flourished in the town before the time of 
Guimarus II, who reigned in the ninth century. In 
the ancient chronicle of Salerno, re-discovered by De 
Kenzi and published in his " Collectio Salernitana," 
it is definitely recorded that the medical school was 
founded by four doctors, a Jewish Rabbi Elinus, 
a Greek Pontus, a Saracen Adala, an Arab, and a 
native of Salerno, each of whom lectured in his 
native language. There are many elements in this 
tradition, however, that would seem to indicate its 
mythical origin and that it was probably invented 
after the event to account for the presence of teach 
ers in all these languages and the coming of students 
from all over the world. The names, for instance, 
are apparently corruptions of real names, as can be 
readily recognized. Elinus, the Jew, is probably 
Elias or Eliseus, Adala is a corruption of Abdallah, 
and Pontus, as pointed out by Puschmann in his 
" History of Medical Education," should probably 
be Gario-Pontus. 

While we do not know exactly when the medical 
school at Salerno was founded, we know that a hos- 


pital was established there as early as 820. It was 
founded by the Archdeacon Adelmus, and was 
placed under the control of the Benedictines after it 
was realized that a religious order, by its organiza 
tion, was best fitted for carrying on such charitable 
work continuously. Other infirmaries and charitable 
institutions, mainly under control of the religious, 
sprang up in Salerno. It was the presence of these 
hospitals in a salubrious climate that seems first to 
have attracted the attention of patients and then of 
physicians from all over Europe and even adjacent 
Africa and Asia. Puschmann says that it is uncer 
tain whether clinical instruction was imparted in 
these institutions or not, but the whole tenor of what 
we know about the practical character of the teach 
ing at Salerno and of the fine development of profes 
sional medicine there, would seem to argue that 
probably those who came to study medicine here 
were brought directly in contact with patients. 

As early as the ninth century Salerno was famous 
for its great physicians. "We know the names of at 
least two physicians, Joseph and Joshua, who prac 
tised there about the middle of the ninth century. 
Ragenifrid, a Lombard by his name, was private 
physician to Prince Wyamar of Salerno in the year 
900. The fact that he was from North Italy indi 
cates that already foreigners were being attracted, 
but more than this that they were obtaining oppor 
tunities unhampered by any Chauvinism. From 
early in the tenth century physicians from Salerno 
were frequently brought to foreign courts to become 
the attending physicians to rulers. Patients of the 
highest distinction from all over Europe began to 


flock to Salerno, and we have the names of many of 
them. In the tenth century Bishop Adalberon, 
when ailing, went there, though he found no cure 
for his ills. Abbot Desiderius, however, the great 
Benedictine scholar of the time, who afterwards be 
came Pope Victor III, regained his health at Sa 
lerno under the care of the great Constantine Afri- 
canus, who was so much impressed by the gentle 
kindness and deep learning and the example of the 
saintly life of his patient that not long after he went 
to Monte Cassino to become a Benedictine under 
Desiderius, who was abbot there. Duke Guiscard 
sent his son Bohemund to Salerno for the cure of 
a wound received in battle, which had refused to 
heal under the ordinary surgical treatment of the 
time. William the Conqueror, early in the eleventh 
century and while still only the Duke of Normandy, 
is said to have passed some time at Salerno for a 
similar reason. 

The most interesting feature of the medical life at 
Salerno at this time is the relations between the 
clergy and the physicians. In the sketch of the life 
of Constantine Africanus, which follows this chap 
ter, there is some account of the friendship between 
Abbot Desiderius of Monte Cassino and Constantine 
Africanus, and the latter s withdrawal from his pro 
fessorship to become a Benedictine. One of the phy 
sicians of the early tenth century who stood high in 
favor with Prince Gisulf was raised to the Bishopric 
of .Salerno. This was Alphanus, whom we have al 
ready mentioned as a chronicler, a monk, a poet, a 
physician, and finally the Bishop of Salerno. 

The best proof of how thorough was the medical 


education at Salerno and how much influence it ex 
erted even over public opinion is to be found in the 
regulation of the practice of medicine, which soon 
began, and the insistence upon proper training be 
fore permission to practise medicine was granted. 
The medical school at Salerno early came to be a 
recognized institution in the kingdom of the Two 
Sicilies, representing a definite standard of medical 
training. It is easy to understand that the attrac 
tion which Salerno possessed for patients soon also 
brought to the neighborhood a number of irregular 
physicians, travelling quacks, and charlatans. 
Wealthy patients were coming from all over the 
world to be treated at Salerno. Many of them doubt 
less were sufferers from incurable diseases and noth 
ing could be done for them. Often they would be 
quite unable to return to their homes and would be 
surely unwilling to give up all hope if anybody prom 
ised them anything of relief. There was a rich field 
for the irregular, and of course, as always, he came. 
Salerno had already shown what a good standard of 
medical education should be, and it is not surprising, 
then, that the legal authorities in this part of the 
country proceeded to the enforcement of legal regu 
lations demanding the attainment of this standard, 
in order that unfit and unworthy physicians might 
not practise medicine to their own benefit but to the 
detriment of the patients. 

Accordingly, as early as the year 1140, King Kug- 
giero (Roger) of the Two Sicilies promulgated the 
law: " Whoever from this time forth desires to prac 
tise medicine must present himself before our of 
ficials and judges, and be subject to their decision. 


Anyone audacious enough to neglect this shall be 
punished by imprisonment and confiscation of goods. 
This decree has for its object the protection of the 
subjects of our kingdom from the dangers arising 
from the ignorance of practitioners." 

Just about a century later the Emperor Frederick 
II, the Hohenstaufen, in the year 1240, extended this 
law, emphasized it, and brought it particularly into 
connection with the great medical school of the Two 
Sicilies, of which territory he was the ruler. This 
law has often been proclaimed as due to his person 
ality rather than to his times, as representing his 
very modern spirit and his progressive way of look 
ing at things. There is no doubt that certain per 
sonal elements for which he should be given due 
credit are contained in the law. To understand it 
properly, however, one must know the law of King 
Roger of the preceding century; and then it is easy 
to appreciate that Frederick s regulation is only 
such a development of the governmental attitude to 
ward medical practice as might have been expected 
during the century since Roger s time. It has some 
times been suggested that this law made by the Em 
peror Frederick, who was so constantly in bitter 
opposition to the Papacy, was issued in despite of the 
Church authorities and represents a policy very dif 
ferent from any which they would have encouraged. 
The early history of Salerno, even briefly as we 
have given it, completely contradicts any such idea. 
The history of medical regulation at the beginning of 
the next century down at Montpellier moreover, 
where the civil authorities being weak the legal or 
dering of the practice of medicine was effectively 


taken up by the Church, and the authority for the 
issuance of licenses to practise was in the hands of 
the bishops of the neighborhood, shows clearly that 
it is not because of any knowledge of the real medical 
history of the times that such remarks are made, but 
from a set purpose to discredit the Church. 

The Emperor Frederick s law deserves profound 
respect and consideration because of the place that 
it holds in the legal regulation of the practice of 
medicine. Anyone who thinks that evolution must 
have brought us in seven centuries much farther in 
this matter than were the people of the later Middle 
Ages should read this law attentively. Everyone 
who is interested in medical education should have 
a copy of it near him, because it will have a chasten 
ing effect in demonstrating not only how little we 
have done in the modern time rather than how much, 
but above all how much of decadence there was dur 
ing many periods of the interval. The law may 
be found in the original in " The Popes and 
Science " (Fordham University Press, N. Y., 1908). 
Three years of preliminary university education be 
fore the study of medicine might be taken up, four 
years of medical studies proper before a degree was 
given, a year of practice with a regularly licensed 
physician before a license to practise could be ob 
tained, a special course in anatomy if surgery were 
to be practised; all this represents an ideal we are 
striving after at the present time in medical edu 
cation. Besides this, Frederick s law also regulates 
medical fees, requires gratuitous attendance on the 
poor for the privilege of practice accorded by the 
license, though the general fees are of a thoroughly 


professional character and represent for each visit 
of the physician about the amount of daily wage that 
the ordinary laborer of that time earned. Curiously 
enough, this same ratio of emolument has maintained 
itself. This law was also a pure drug law, regulat 
ing the practice of pharmacy, and the price as well 
as the purity of drugs, and the relations of phy 
sicians, druggists, and the royal drug inspectors 
whose business it was to see that only proper drugs 
were prepared and sold. 

All this is so much more advanced than we could 
possibly have imagined, only that the actual docu 
ments are in our possession, that most people refuse 
to let themselves be persuaded in spite of the law 
that it could have meant very much. Especially as 
regards medical education are they dubious as to 
conditions at this time. To them it seems that it 
can make very little difference how much time was 
required for medical study or for studies prelim 
inary to medicine, since there was so little to be 
learned. The age was ignorant, men knew but little, 
and so very little could be imparted no matter how 
much time was taken. 

This is, I fear, a common impression, but an ut 
terly false one. The preliminary training that is 
the undergraduate work at the universities consisted 
of the Seven Liberal Arts the trivium and quad- 
rivium, which embraced logic, rhetoric, grammar, 
metaphysics, under which was included not a little 
of physics, cosmology in which some biology was 
studied, as well as psychology and mathematics, as 
tronomy, and music. This was a thoroughly 
rounded course in intellectual training. No wonder 


that Professor Huxley said in his Inaugural Ad 
dress as Kector of Aberdeen, " I doubt if the cur 
riculum of any modern university shows so clear and 
generous a comprehension of what is meant by cul 
ture as this old trivium and quadrivium does." 
There is no doubt at all about the value of the under 
graduate training, nor of the scholarship of the men 
who were turned out under the system, nor of their 
ability to concentrate their minds on difficult sub 
jectsa faculty that we strive to cultivate in our 
time and do not always congratulate ourselves on 
securing to the degree, at least, that we would like. 

As to the medical teaching, ^3Egidius, often called 
Gilles of Corbeil, who was a graduate of Salerno 
and afterward became the physician-in-ordinary to 
Philip Augustus, King of France, thought that he 
could not say too much for the training in medicine 
that was given at this first of the medical schools. 
One thing is sure, the professors were eminently 
serious, the work taken up was in many ways thor 
oughly scientific, and some of the results of the 
medical investigations of that early day are inter 
esting even now. The descriptions of diseases that 
we have from the Salernitan school are true to na 
ture and are replete with many original observa 
tions. Puschmann says: " The accounts given of 
intermittent fever, pneumonia, phthisis, psoriasis, 
lupus, which they called the malum rnortuurn, of 
ulcers on the sexual organs, among which it is easy 
to recognize chancre, and of the disturbances of the 
mental faculties, especially deserve mention." They 
seem to have been quite expert in their knowledge of 
phthisis. In the treatment of it they laid great 


stress upon the giving up of a strenuous life, the 
living a rather easy existence in the open air, and a 
suitable diet. "When the commencement of consump 
tion was suspected, the first prescription was a good 
course of strengthening nourishment for the pa 
tient. On the other hand, they declared that the 
cases in which diarrhea supervened during consump 
tion soon proved fatal. In general, with regard to 
people who were liable to respiratory diseases, they 
insisted upon life in an atmosphere of equable tem 
perature. Though the custom was almost unheard 
of in the Salerno of that time, and indeed at the 
present time there is very little heating during the 
winter in southern Italy, they insisted that patients 
who were liable to pulmonary affections should have 
their rooms heated. 

On the other hand, they suggested the cooling of 
the air of the sick-room, as we have noted in the 
chapter on Constantine Africanus, and Afflacius rec 
ommended the employment of an apparatus from 
which water trickled continuously in drops to the 
ground and then evaporated. Baths and bleeding 
were employed according to definite indications and 
diet was always a special feature. They had a num 
ber of drugs and simples, and the employment of 
some of them, is interesting. Iron was prescribed 
for enlargement of the spleen. The internal use of 
sea sponge, in which of course there is a noteworthy 
proportion of iodine, was recommended for relief 
from the symptoms of goitre by reducing its size. 
Iodine has been used so much ever since in this af 
fection, even down to our own day, that this employ 
ment of one of its compounds is rather striking. 


Massage of the goitre was also recommended, and 
this mode of treatment was commonly employed for 
a number of ailments. 

Probably the best idea that can be obtained in 
brief space of the achievements of the University 
of Salerno is to be found in Pagel s appreciation of 
Salerno s place in the history of medicine in his 
chapters on " Medicine in the Middle Ages in 
Puschmann s " Handbuch der Geschichte der Me- 
dizin ( Berlin, 1902 ) . He said : " If we take up now 
the accomplishments of the school of Salerno in the 
different departments there is one thing that is very 
remarkable. It is the rich independent productivity 
with which Salerno advanced the banners of medical 
science for hundreds of years almost as the only au 
tochthonous centre of medical influence in the whole 
West. One might almost say that it was like a 
versprengten Keim a displaced embryonic ele 
ment which, as it unfolded, rescued from destruc 
tion the ruined remains of Greek and Roman medi 
cine. This productivity of Salerno, which may well 
be compared in quality and quantity with that of 
the best periods of our science, and in which no de 
partment of medicine was left without some ad 
vance, is one of the striking phenomena of the history 
of medicine. While positive progress was not made, 
there are many noteworthy original observations to 
be chronicled. It must be acknowledged that pupils 
and scholars set themselves faithfully to their tasks 
to further as far as their strength allowed the sci 
ence and art of healing. In the medical writers of 
the older period of Salerno who had not yet been 
disturbed by Arabian culture or scholasticism, we 


cannot but admire the clear, charmingly smooth, 
light-flowing diction, the delicate and honest setting 
forth of cases, the simplicity of their method of 
treatment, which was to a great extent dietetic and 
expectant, and while we admire the carefulness and 
yet the copiousness of their therapy, we cannot but 
envy them a certain austerity in their pharmaceutic 
formulas and an avoidance of medicamental poly- 
pragmasia. The work in internal medicine was espe 
cially developed. The contributions to it from a 
theoretic and a literary standpoint, as well as from 
practical applications, found ardent devotees." 

Less than this could scarcely have been expected 
from the medical school which brought such an up 
lift of professional dignity and advance in the stand 
ards of medical education that are to be noticed in 
connection with Salerno. Eegistration, licensure, 
preliminary education, adequate professional studies, 
clinical experience under expert guidance, even spe 
cial training for surgical work, all came in connec 
tion with this great medical school. Such practical 
progress in medical education could not have been 
made but by men who faced the problems of the prac 
tice of medicine without self-deception and solved 
them as far as possible by common-sense, natural, 
and rational methods. 

It is usually said that at Salerno surgery occupied 
an inferior position. It is true that we have less 
record of it in the earlier years of Salerno than we 
would like to see. It was somewhat handicapped by 
the absence of human dissection. This very impor 
tant defect was not due to any Church opposition to 
anatomy, as has often been said, but to the objection 


that people have to seeing the bodies of their friends 
or acquaintances used for anatomical purposes. In 
the comparatively small towns of the Middle Ages 
there were few strangers, and therefore very seldom 
were there unclaimed bodies. The difficulty was in 
the obtaining of dissecting material. "We had the 
same difficulty in this country until about two gen 
erations ago, and the only way that bodies could be 
obtained regularly was by " resurrecting them, 
as it was called, from graveyards. In the ab 
sence of human subjects, anatomy was taught at 
Salerno upon the pig. The principal portion of the 
teaching in anatomy consisted of the demonstration 
of the organs in the great cavities of the body and 
their relations, with some investigations of their 
form and the presumed functions of the correspond 
ing organs in man. Copho s well-known " Anatomy 
of the Pig " was a text-book written for the students 
of Salerno. In spite of its limitations, it shows the 
beginnings of rather searching original inquiry and 
even some observations in pathological anatomy. It 
is simple and straightforward and does not profess 
to be other than it is, though it must be set down as 
the first reasonably complete contribution to com 
parative anatomy. 

When their surgery came to be written down, 
however, it gave abundant evidence of the thorough 
ness with which this department of medicine had 
been cultivated by the Salernitan faculty. "We have 
the test-book of Eoger, with the commentary of Eo- 
lando, and then the so-called commentary of the 
Four Masters. These writings were probably made 
rather for the medical school at Bologna than that 


of Salerno, though there is no doubt that at least 
Roger and Rolando received their education at Sa 
lerno and embodied in their writings the surgical 
traditions of that school. While I have preferred, in 
order to have a connected story of surgical develop 
ment, to treat of their contributions to their specialty 
under the head of the " Great Surgeons of the Me 
dieval Universities," it seems well to point out here 
that they must be considered as representing espe 
cially the surgical teaching of the older medical 
school of Salerno. There are many interesting fea 
tures of the old teaching that they have embodied 
in their books. For instance, at Salerno both sutures 
and ligatures were employed in order to prevent 
bleeding. We are rather accustomed to think of such 
uses of thread, and especially the ligature, as being 
much later inventions. The fact of the matter is, 
however, that ligatures and sutures were reinvented 
over and over again and then allowed to go out of 
use until someone who had no idea of their dangers 
came to reinvent them once more. 1 

lit seems hard to understand how so useful an auxiliary to the 
surgeon as the ligature, it seems indispensable to us, could pos 
sibly be allowed to go out of use and even be forgotten. It will not 
be difficult, however, for anyone who recalls the conditions that 
obtained in old-time surgery. The ligature is a most satisfying 
immediate resource in stopping bleeding from an artery, but a septic 
ligature inevitably causes suppuration and almost inevitably leads 
to secondary hemorrhage. In the old days of septic surgery sec 
ondary hemorrhage was the surgeon s greatest and most dreaded 
bane. Some time from the fifth to the ninth day a septic ligature 
came away under conditions such that inflammatory disturbance had 
prevented sealing of the vessel. If the vessel was large, then the 
hemorrhage was fast and furious and the patient died in a few 
minutes. After a surgeon had had a few deaths of this kind he 


Much is often said about the place of Arabian sur 
gery and medicine at this time, and the influence 
that they had over the medical teaching and think 
ing of the period. To trust many of the shorter 
histories of medicine the Arabs must be given credit 
for more of the medical thought of this time than any 
other medical writers or thinkers. It is forgotten, 
however, apparently, that in the southern part of 
Italy, where Salerno was situated, Greek influence 
never died out. This had been a Greek colony in 
the olden time and continued to be known for many 
centuries after the Christian era as Magna Groecia. 
Greek medicine, then, had more influence here than 
anywhere else. As a matter of fact, the beginnings 
of Salernitan teaching are all Greek and not at all 
Arabian. This is as true in surgery as in medicine. 
I have quoted Gurlt in the chapter on " Great Sur 
geons of the Medieval Universities," insisting that 
the Salernitan school owed nothing at all to Arabian 
surgery. Salernitan medicine was, during the 
twelfth century, just as free from Arabian influence. 
When Arabian medicine makes itself felt, as pointed 
out by Pagel in his " Geschichte der Heilkunde im 
Mittelalter," far from exerting a beneficial influ- 

dreaded the ligature. He abandoned its use and took kindly to such 
methods as the actual cautery, red-hot knives for amputations, and 
the like, that would sear the surfaces of tissues and the blood 
vessels, and not give rise to secondary hemorrhage. A little later, 
however, someone not familiar with secondary risks would reinvent 
the ligature. If he were cleanly in his methods and, above all, if 
he were doing his work in a new hospital, the ligature worked very 
well for a while. If not, it soon fell into innocuous desuetude again, 
jpuschmann: " Handbuch der Geschichte der Medizin," Vol. I, page 


ence, it had a rather unfortunate effect. It led espe 
cially to an oversophistication of medicine from the 
standpoint of drug therapeutics. The Arabian 
physicians trusted nature very little. In this they 
were like our forefathers of medicine one hundred 
years ago, of whom Rush was the typical representa 
tive so history repeats itself. 

Before the introduction of Arabian medicine the 
Salernitan school of medicine was noted for its 
common-sense methods and its devotion to all the 
natural modes of healing. It looked quite as much 
to the prevention of disease as its treatment. Diet 
and air and water were always looked upon as sig 
nificant therapeutic aids. With the coming of Ara 
bian influence there began, says Pagel, " as the lit 
erature of the times shows very well, that rule of 
the apothecary in therapeutics which was an unfor 
tunate exaggeration. Now all the above-mentioned 
complicated prescriptions came to be the order of 
the day. Apparently the more complicated a pre 
scription the better. Dietetics especially was rele 
gated to the background. Salerno, at the end of the 
twelfth century, had already reached its highest 
point of advance in medicine and was beginning to 
decline. Decadence was evident in so far as all the 
medical works that we have from that time are either 
borrowings or imitations from Arabian medicine 
with which eventually Salernitan medical literature 
became confounded. Only a few independent au 
thors are found after this time." This is so very 
different from what is ordinarily presumed to have 
been the case and openly proclaimed by many his 
torians of medicine because apparently they would 


prefer to attribute scientific advance to the Arabs 
than to the Christian scholars of the time, that it is 
worth while noting it particularly. 

Salerno was particularly rich in its medical lit 
erary products. Very often we have not the names 
of the writers. Apparently there is good reason to 
think that a number of the professors consulted to 
gether in writing a book, and when it was issued it 
was considered to be a text-book of the Salernitan 
school of medicine rather than of any particular pro 
fessor. This represents a development of co-opera 
tion on the part of colleagues in medical teaching 
that we are likely to think of as reserved for much 
later times. 

The most important medical writing that comes to 
us from Salerno, in the sense at least of the work that 
has had most effect on succeeding generations, has 
been most frequently transcribed, most often trans 
lated and committed to memory by many generations 
of physicians, is the celebrated Salernitan medical 
poem on hygiene. The title of the original Latin 
was " Regimen Sanitatis Salernitanurn. " It was 
probably written about the beginning of the twelfth 
century. A century or so later it came to be the cus 
tom to call medical books after flowers, and so we 
had the " Lilium Medicinae " and the " Flos Medi- 
cinae down at Montpellier, and this became the 
"Flos Medicinae " of Salerno. Pagel calls it the 
quintessence of Salernitan therapeutics. 

For many centuries portions at least of this Latin 
medical poem were as common in the mouths of 
physicians all over Europe as the aphorisms of Hip 
pocrates or the sayings of Galen. Probably this en- 


ables us to understand the great reputation that the 
Salernitan school enjoyed and the influence that it 
wielded better than anything else. The poem is di 
vided into ten principal parts, containing altogether 
about 3,500 lines. The first part on hygiene has 855 
lines in eight chapters. The second part on -materiel 
medico- , though containing only four chapters, has 
also about 800 lines. Anatomy and physiology 
are crowded into about 200 lines, etiology has some 
thing over 200, semiotics has about 250, pathology 
has but thirty lines more or less, and therapeutics 
about 400 ; nosology has about 600 more, and finally 
there is something about the physician himself, and 
an epilogue. As Latin verses go, when written for 
such purposes, these are not so bad, though some 
of them would grate on a literary ear. The whole 
work makes a rather interesting compendium of 
medicine, with therapeutic indications and contra 
indications, and whatever the physician of the me 
dieval period needed to have ready to memory. 
Some of its prescriptions, both in the sense of 
formulse and of directions to the patient, have quite 
a modern air. 

One very interesting contribution to medical lit 
erature that comes to us from Salerno bears the title, 
" The Coming of a Physician to His Patient, or An 
Instruction for the Physician Himself." "We have 
had a number of such works published in recent 
years, but it is a little surprising to have the subject 
taken up thus early in the history of modern pro 
fessional life. It is an extremely valuable document, 
as demonstrating how practical was the teaching at 
Salerno. The work is usually ascribed to Archi- 


mattheas, and it certainly gives a vivid picture of 
the medical customs of the time. The instruction for 
the immediate coming of the physician to his patient 
runs as follows : When the doctor enters the dwell 
ing of his patient, he should not appear haughty, 
nor covetous, but should greet with kindly, modest 
demeanor those who are present, and then seating 
himself near the sick man accept the drink which is 
offered him (sic) and praise in a few words the 
beauty of the neighborhood, the situation of the 
house, and the well-known generosity of the family, 
if it should seem to him suitable to do so. The pa 
tient should be put at his ease before the examination 
begins and the pulse should be felt deliberately and 
carefully. The fingers should be kept on the pulse at 
least until the hundredth beat in order to judge its 
kind and character; the friends standing round will 
be all the more impressed because of the delay and 
the physician s words will be received with just that 
much more attention." 

The old physician evidently realized very well ho\v 
much influence on the patient s mind meant for the 
course of the disease. For instance, he recommends 
that the patient should be asked to confess and re 
ceive the sacraments of the Church before the doc 
tor sees him, for if mention is afterwards made of 
this the patient may believe that it is because the 
doctor thinks that there is no hope for him. For 
the purpose of producing an effect upon the patient s 
mind, the old physician does not hesitate even to 
suggest the taking advantage of every possible 
source of information, so as to seem to know all about 
the case. " On the way to see the sick person he 


[the physician] should question the messenger who 
has summoned him upon the circumstances and the 
conditions of the illness of the patient; then, if not 
able to make any positive diagnosis after examining 
the pulse and the urine, he will at least excite the 
patient s astonishment by his accurate knowledge 
of the symptoms of the disease and thus win his 

At the end of these preliminary instructions there 
is a rather diplomatic to say the least bit of ad 
vice that might perhaps to a puritanic conscience 
seem more politic than truthful. Since the old pro 
fessor insists so much on not disturbing the pa 
tient s mind by a bad prognosis or any hint of it, 
and since even some exaggeration of what he might 
think to be the serious outlook of the case to friends 
would only lead to greater care of the patient, there 
is probably much more justification for his sugges 
tion than might be thought at first glance. He says, 
When the doctor quits the patient he should prom 
ise him that he will get quite well again, but he 
should inform his friends that he is very ill; in this 
way, if a cure is affected, the fame of the doctor 
will be so much the greater, but if the patient dies 
people will say that the doctor had foreseen the fatal 


The story of the medical school of Salerno, even 
thus briefly and fragmentarily told, illustrates very 
well how old is the new in education, even in medi 
cal education. There is scarcely a phase of modern 
interest in medical education that may not be traced 
very clearly at Salerno though the school began its 
career a thousand years ago, and ceased to attract 


much attention over six hundred years ago. "We owe 
most of our knowledge of the details of its organiza 
tion and teaching to De Kenzi. Without the devo 
tion of so ardent a scholar it would have been almost 
impossible for us to have attained so complete a pic 
ture of Salernitan activities. As it is, as a conse 
quence of his work we are able to see this first of 
modern medical schools developing very much as do 
our most modern medical schools. There has been 
an accumulation of medical information in the thou 
sand years, but the ways and modes of facing prob 
lems and many of the solutions of them do not differ 
from what they were in the distant past. The more 
we know about any particular period, the more is this 
brought home to us. It is for this that study of par 
ticular periods and institutions of the olden time, as 
of Salerno, grows increasingly interesting, because 
each new detail helps to fill in sympathetically the 
new-old picture of human activity as it may be seen 
at all times. 


Probably the most important representative of 
the medical school at Salerno, certainly the most 
significant member of its faculty, if we consider the 
wide influence for centuries after his time that his 
writings had, was Constantine Africanus. He is in 
teresting, too, for many other reasons, for he is the 
first representative, in modern times, that is, who, 
after the incentive of antiquity had passed, devoted 
himself to creating a medical literature by transla 
tions, by editions, and by the collation of his own 
and others observations on medical subjects. He 
is the connecting link between Arabian medicine and 
Western medical studies. The fact that he was first 
a traveller over most of the educational world of his 
time, then a professor at the University of Salerno 
who attracted many students, and finally a Bene 
dictine monk in the great abbey at Monte Cassino, 
shows how his life ran the gamut of the various 
phases of interest in the intellectual world of his 
time. It was his retirement to the famous mon 
astery that gave him the opportunity, the leisure, 
the reference library for consultation that a writer 
feels he must have near him, and probably also the 
means necessary for the publication of his works. 
Not only did the monks of Monte Cassino itself de- 



vote themselves to the copying of his many books, 
but other Benedictine monasteries in various parts 
of the world made it a point to give wide diffusion 
to his writings. 

As a study in successful publication, that is, in 
the securing of wide attention to writings within a 
short time, the career of Constantine and the story 
of his books would be extremely interesting. 
Medieval distribution of books is usually thought to 
have been rather halting, but here was an exception. 
It was largely because Benedictines all over the 
world were deeply interested in what this brother 
Benedictine was writing that wide distribution was 
secured for his work within a very short time. His 
superiors among the Benedictines had a profound 
interest in what he was doing. The great Bene 
dictine Abbot Desiderius of Monte Cassino, who 
afterwards became Pope, used all of his extensive 
influence in both positions to secure an audience for 
the books hence the many manuscript copies of 
his writings that we have. It is probable that Con 
stantine established a school of writers at Monte 
Cassino, for he could scarcely have accomplished so 
much by himself as has been attributed to him. Be 
sides, his works attracted so much attention that 
writers of immediately succeeding generations who 
wanted to secure attention for their works some 
times attributed them to him in order to take ad 
vantage of his popularity. It is rather difficult, 
then, to determine with absolute assurance which 
are Constantine s genuine works. Some of those 
attributed to him are undoubtedly spurious. "\Vhat 
we know with certainty, however, is that his 


authentic works meant much for his own and after 

Constantine was born in the early part of the elev 
enth century, and died near its close, having lived 
probably well beyond eighty years of age, his years 
running nearly parallel with his century. His sur 
name, Africanus, is derived from his having been 
born in Africa, his birthplace being Carthage. Early 
in life he seems to have taken up with ardor the 
study of medicine in his native town, devoting him 
self, however, at the same time to whatever of phys 
ical science was available. Like many another 
young man since his time, not satisfied with the 
knowledge he could secure at home, he made distant 
journeys, gathering medical and scientific informa 
tion of all kinds wherever he went. According to 
a tradition that seems to be well grounded, some of 
these journeys took him even into the far East. 
During his travels he became familiar with a num 
ber of Oriental languages, and especially studied 
the Arabian literature of science very diligently. 

At this time the Arabs, having the advantage of 
more intimate contact with the Greek medical tradi 
tions in Asia Minor, were farther advanced in their 
knowledge of the medical sciences than the scholars 
in the West. They had better facilities for obtain 
ing the books that were the classics of medicine, and, 
with any desire for knowledge, could scarcely fail 
to secure it. 

What was best in Arabian medicine was brought 
to Salerno by Constantine and, above all, his trans 
lation of many well-known Arabian medical authors 
proved eminently suggestive to seriously investigat- 


ing physicians all over the world in his time. Be 
fore he was to be allowed to settle down to his 
literary work, however, Constantine was to have a 
very varied experience. Some of this doubtless was 
to be valuable in enabling him to set the old Arabian 
teachers of medicine properly before his generation. 
After his Oriental travels he returned to his native 
Carthage in order to practise medicine. It was not 
long, however, before his superior medical knowl 
edge, or, at least, the many novelties of medical 
practice that he had derived from his contact with 
the East, drew upon him the professional jealousy 
of his colleagues. It is very probable that the repu 
tation of his extensive travels and wide knowledge 
soon attracted a large clientele. This was followed 
quite naturally by the envy at least of his pro 
fessional brethren. Feeling became so bitter, that 
even the possibility of serious personal conse 
quences for him because of false accusations was 
not out of the question. Whenever novelties are 
introduced into medical science or medical practice, 
their authors are likely to meet with this opposition 
on the part of colleagues, and history is full of ex 
amples of it. Galvani was laughed at and called the 
frogs dancing-master; Auenb rugger was made fun 
of for drumming on people ; Harvey is said to have 
lost half of his consulting practice; all because they 
were advancing ideas that their contemporaries 
were not ready to accept. We are rather likely to 
think that this intolerant attitude of mind belongs 
to the older times, but it is rather easy to trace it in 
our own. 
In Constantine s day men had ready to hand a 


very serious weapon that might be used against in 
novators. By craftily circulated rumors the pop 
ulace was brought to accuse him of magical prac 
tices, that is, of producing his cures by association 
with the devil. We are rather prone to think little 
of a generation that could take such nonsense seri 
ously, but it would not be hard to find analogous 
false notions prevalent at the present time, which 
sometimes make life difficult, if not dangerous, for 
well-meaning individuals. 1 Life seems to have been 
made very uncomfortable for Constantine in 
Carthage. Just the extent to which persecution 
went, however, we do not know. About this time 
Constantine s work attracted the attention of Duke 
Eobert of Salerno. He invited him to become his 
physician. After he had filled the position for a time 
a personal friendship developed, and, as has often 
happened to the physicians of kings, he became a 
royal counsellor and private secretary. When the 
post of professor of medicine at Salerno fell vacant, 
it is not surprising, then, that Constantine should 
have been made professor, and from here his teach 
ing soon attracted the attention of all the men of 
his time. 

Constantine seems to have greatly enhanced the 
reputation of the medical school, and added to the 
medical prestige of Salerno. After teaching for some 
ten years there, however, he gave up his professor 
ship the highest position in the medical world of 
the time apparently with certain plans in mind. 

1 The first dentist who filled teeth with amalgam in New York, 
some eighty years ago, had to flee for his life, because of a hue and 
cry set up that he was poisoning his patients with mercury. 


He wanted leisure for writing the many things in 
medicine that he had learned in his travels in the 
East, so as to pass his precious treasure of knowl 
edge on to succeeding generations ; and then, too, he 
seems to have longed for that peace that would 
enable him not only to do his writing undisturbed, 
but to live his life quietly far away from the strife 
of men and the strenuous existence of a court and of 
a great school. 

There was probably another and more intimate 
personal reason for his retirement. Abbot Desi- 
derius of the Benedictine Abbey of Monte Cassino, 
not far away, had become a close and valued friend. 
Before having been made abbot, Desiderius and 
Constantine probably were fellow professors at 
Salerno, for we know that Desiderius himself and 
many of his fellow Benedictines taught in the under 
graduate department there. Desiderius enjoyed 
the reputation of being one of the most learned men 
of the time when his election to the abbacy at Monte 
Cassino took him away from Salerno. His de 
parture was a blow to Constantine, who had learned 
by years of friendship that to be near his intimate 
friend, the pious scholarly Benedictine, was a solace 
in life and a never failing incentive to his own in 
tellectual work. Desiderius seems, indeed, to have 
been a large factor in influencing the great physi 
cian to write his books rather than devote himself to 
oral teaching, since the circulation of his writing 
would confer so much more of benefit on a greater 
number of people. Perhaps another element in the 
situation was that Desiderius was desirous of hav 
ing the learned physician, the travelled scholar, at 


Monte Cassino, for the sake of his influence on the 
scholarship of the abbey, and for the incentive that 
he would be to the younger monks to apply them 
selves to the varied field of knowledge which the 
Benedictines had chosen for themselves at this time. 

Whatever hopes of mutual solace and helpfulness 
and of the joys of intimate close friendship may 
have been in the minds of these two most learned 
men of their time, they were destined to be grievously 
disappointed. Only a few years after Constantine s 
entrance into the monastery at Monte Cassino Desi- 
derius was elected Pope. The humble Benedictine 
did not want to take the exalted position, but it was 
plainly shown to him that it was his duty, and that 
he must not shirk it. Accordingly, under the name 
of Pope Victor III, he became one of the great 
Popes of the eleventh century. One might think 
that he could have summoned Constantine to Rome, 
but perhaps he knew that his friend would prefer 
the quietude of the cloister, and then, too, probably 
he wanted to allow him the opportunity to accom 
plish that writing for which Constantine and him 
self had planned when the great physician entered 
the monastery. 

All that we know for sure is that some twenty 
years of Constantine s life were spent as a monk in 
Monte Cassino, where he devoted his time mainly 
to the writing of his books. One bond of union there 
was. Each of the works, as soon as completed, 
was sent off to the Pope as long as he lived. On 
the other hand, though busy with his Papal duties, 
Pope Victor constantly stimulated Constantine, even 
from distant Rome, to go on with his work. There 


were messages of brotherly interest and solicitude 
just as in the old days. The great African physi 
cian s best known work, the so-called " Liber Pan- 
tegni," which is really a translation of the " Khitaab 
el Maleki " of Ali Ben el- Abbas, is dedicated to Desi- 
derius. Constantine wrote a number of other books, 
most of them original, but it is difficult now to de 
cide just which of those that pass under his name 
are genuine. Many were subsequently attributed to 
him that are surely not his. 

These translators of the Middle Ages proved to 
be not only the channels through which informa 
tion came to their generations, but they were also 
incentives to study and investigation. It is when 
men can get a certain amount of information rather 
easily that they are tempted to seek further in 
order to solve the problems that present themselves. 
There are three great translators whose work meant 
much for the Middle Ages at this time. They were, 
besides Constantine in the eleventh century, Gerard 
of Cremona, in the twelfth, and the Jewish Faradj 
Ben Salim, at Naples, in the thirteenth. Gerard did 
in Spain for the greater Arabian writers what Con 
stantine had accomplished for those of lesser im 
port. Under the patronage of the Emperor Fred 
erick Barbarossa, he published translations of 
Rhazes, Isaac Judaeus, Serapion, Abulcasis, and Avi- 
cenna. His work was done in Toledo, the city in 
which, during the twelfth and thirteenth centuries, 
so many translators were at work making books for 
the Western world. 

Constantine did much more than merely bring out 
his translations of Arabian works. He gave a zest to 


the study of the old masters, issued editions of cer 
tain, at least, of the works of Hippocrates (" Apho 
risms ") and Galen (" Microtechnics "), and, in gen 
eral, called attention to the precious treasure of rned- 
ical lore that must be used to advantage if men were 
to teach the rising generation out of the accumulated 
knowledge of the past. Pagel, in Puschmann s 
" Handbook," does not hesitate to say that " a 
farther merit of Constantine must be recognized, 
inasmuch as that not long after his career the sec 
ond epoch of the school of Salerno begins, marked 
not only by a wealth of writers and writings on 
medicine, but, above all, because from this time on 
the study of Greek medicine received renewed en 
couragement through the Latin versions of the 
Arabian literature. We may think as we will of 
the worth of these works, but this much is sure, that 
in many ways they brought about a broadening 
and an improvement of Greek knowledge, especially 
from the pharmacopeia standpoint." 

Probably the best evidence that we have for Con 
stantine s influence on his generation is to be found 
in what was accomplished by men who acknowledged 
with pride that he was their master, and who 
thought it a mark of distinction to be reckoned as 
his disciples. 

Among these especially noteworthy is Johannes 
Afflacius, or Saracenus (whose surname of the Sara 
cen probably means that he, too, came from Africa, 
as his master did). He was the author of two 
treatises on " Fevers and Urines," and the so- 
called " Cures of Afflacius." Some of these cures he 
directly attributed to Constantine. Then there is a 


Bartholomew who wrote a " Practica," or " Manual 
of the Practice of Medicine," with the sub-title, 
" Introductions to and Experiments in the Medical 
Practice of Hippocrates, Constantine, and the Greek 
Physicians." Bartholomew represents himself as a 
disciple of Constantine. This " Practica of 
Bartholomew was one of the most commonly used 
books of the twelfth and thirteenth centuries 
throughout Europe. There are manuscript com 
mentaries and translations, and abstracts from it 
not only in the Latin tongues, but especially in the 
Teutonic languages. Pagel refers to manuscripts 
in High and Low Dutch, and even in Danish. The 
Middle High Dutch manuscripts of this " Practica " 
of Bartholomew come mainly from the thirteenth 
century, and have not only a special interest be 
cause of their value in the history of philology, but 
because they are the main sources of all the later 
books on drugs which appeared in very large num 
bers in German. They have a very great historico- 
literary interest, especially for pharmacology. 

To Afflacius we owe a description of a method of 
reducing fever that is not only ingenious, but, in 
the light of our recently introduced bathing methods 
for fever, is a little startling. In his book on 
Fevers and Urines," Afflacius suggests that when 
the patient s fever makes him very restless, and 
especially if it is warm weather, a sort of shower 
bath should be given to him. He thought that rain 
water was the best for this purpose, and he de 
scribes its best application as in rainy fashion, modo 
pluvwli. The water should be allowed to flow down 
over the patient from a vessel with a number of 


minute perforations in the bottom. A number of 
the practical hints for treatment given by Afflacius 
have been attributed to Constantine. 

Constantine s reputation has, in the opinion of 
some writers, been hurt by two features of his pub 
lished works, as they have come to us, that we find 
it difficult to understand. One of these is that his 
translations from the Arabic were made mainly 
not of the books of the great leaders of Arabian 
medicine, but from certain of the less important 
writers. The other is that it does not seem always 
to have been made clear in the manuscripts that 
have come down to us, whether these writings were 
translations or original writings. Some have even 
gone so far as to suggest that Constantine himself 
would have been quite willing to receive the credit 
for these writings. 

As to the first of these objections, it may be said 
that very probably Constantine, in his travels, had 
come to realize that the books of the great Arabian 
physicians, Rhazes, Abulcasis, Avicenna, and others, 
already received so much attention that the best 
outlook for medicine was to call particular notice 
to the writings of such lesser lights as Ali Abbas, 
Isaac Judasus, Abu Dschafer, and others of even 
less note. Certainly we cannot but feel that his 
judgment in the matter must have been directed 
by reasons that we may not be able to understand at 
present, but that must have existed, for all that 
we know of the man proves his character as a prac 
tical, far-sighted scholar. Besides, it seems not un 
likely that but for his interest in them we would not 
at the present time possess the translations of these 


minor Arabian writers, and that would be an un 
fortunate gap in medical history. 

The other misunderstanding with regard to Con- 
stantine refers to the fact that it is now almost im 
possible to decide which are his own and which are 
the writings of others. It has been said that he 
even tried to palm off some of the writings of others 
as his own. This seems extremely unlikely, how T 
ever, knowing all that we do about his life ; and the 
suspicion is founded entirely on manuscripts as we 
have them at the present time, about a thousand 
years after he lived. What mutilations these manu 
scripts underwent in the course of various copyings 
is hard now to estimate. Monastic copyists might 
very well have left out Arabian names, because they 
were mainly interested in the fact that they were 
providing for their readers works that had received 
the approval of Constantine, and the translation of 
which at least had been made under his direction. 
It is quite clear that he did not do all the translat 
ing himself, and that he probably must have organ 
ized a school of medical translators at Monte Cas- 
sino. Then just how the various works would be 
looked at is very dubious. Undoubtedly many of the 
translations were done after his death, or certainly 
finished after his time, and at last attributed to 
him, because he was the moving spirit and had prob 
ably selected the books that should be translated, and 
made suggestions with regard to them. For all of 
his monks he was, as masters have ever been for 
disciples, much more important, and rightly so, than 
those writers to whom he referred them. 

The whole question of plagiarism in these 


medieval times, as I have pointed out elsewhere, is 
entirely different from that of the present time. 
Now a writer may consciously or unconsciously 
claim another writing as his own. We have come 
to a time when men think much of their individual 
reputations. It was no uncommon thing, however, 
in the Middle Ages, and even later in the Eenais- 
sance, for a writer to attribute what he had writ 
ten to some distinguished literary man of the pre 
ceding time, and sign that writer s name to his own 
work. The idea of the later author was to secure 
an audience for his thoughts. He seemed to be quite 
indifferent whether people ever knew just who the 
writer was, but he wanted to influence humanity by 
his writings. He thought much more of this than 
of any possible reputation that might come to him. 
Of course, there was no question of money. There 
never has been any question of money-making when 
ever the things written have been really worth while. 
Literature that has deeply influenced mankind has 
never paid. Publications that have paid are insig 
nificant works that have touched superficially a whole 
lot of people. To think of Constantine as a pla 
giarist in our modern sense of the word, as trying 
to take the credit for someone else s writings, is to 
misunderstand entirely the times in which he lived, 
and to ignore the real problem of plagiarism at that 

With the accumulation of information with re 
gard to the history of medicine in his time, Con 
stantine s reputation has been constantly enhanced. 
It is not so long since he was considered scarcely 
more than a monkish chronicler, who happened to 


have taken medicine rather than history for his 
field of work. Gradually we have come to appre 
ciate all that he did for the medicine of his time. 
Undoubtedly his extensive travels, his wide knowl 
edge, and then his years of effort to make Oriental 
medicine available for the "Western civilization that 
was springing up again among the peoples who had 
come to replace the Komans, set him among the 
great intellectual forces of the Middle Ages. 
Salerno owed much to him, and it must not be for 
gotten that Salerno was the first university of mod 
ern times, and, above all, the first medical school 
that raised the dignity of the medical profession, 
established standards of medical education, edu 
cated the public mind and the rulers of the time to 
the realization of the necessity for the regulation 
of the practice of medicine, and in many ways an 
ticipated our modern professional life. That the 
better part of his life work should have been done 
as a Benedictine only serves to emphasize the place 
that the religious had in the preservation and the 
development of culture and of education during the 
Middle Ages. 


Very probably the most interesting chapter for 
us of the modern time in the history of the medical 
school at Salerno is to be found in the opportunities 
provided for the medical education of women and 
the surrender to them of a whole department in the 
medical school, that of Women s Diseases. While 
it is probable that Salerno did not owe its origin 
to the Benedictines, and it is even possible that there 
was some medical teaching there for all the cen 
turies of the Middle Ages from the Greek times, for 
it must not be forgotten that this part of Italy was 
settled by Greeks, and was often called Magna 
Graecia, there is no doubt at all that the Bene 
dictines exercised great influence in the counsels 
of the school, and that many of the teachers were 
Benedictines, as were also the Archbishops, who 
were its best patrons, and the great Pope Victor III, 
who did much for it. For several centuries the 
Benedictines represented the most potent influence 
at Salerno. 

For most people who are not intimately familiar 
with monastic life, and, above all, with the story 
of the Benedictines, their prestige at Salerno might 
seem to be enough of itself to preclude all possibility 
of the education of women in medicine at Salerno. 
For those who know the Benedictines well, however, 



such a departure as the accordance of opportunities 
for women to study medicine would seem eminently 
in keeping with the practical wisdom of their rules 
and the development of their work. From the be 
ginning the Benedictines recognized that a monastic 
career should be open to women as well as to men, 
and Benedict s sister, Scholastica, established con 
vents for them, as her brother did the Benedictine 
monasteries, thus providing a vocation for women 
who did not feel called upon to marry. That the 
members of the order should recognize the advisabil 
ity of affording women the opportunity to study 
medicine, and of handing over to them the depart 
ment of women s diseases in a medical school in 
which they had a considerable amount of authority, 
seems, then, indeed, only what might have been ex 
pected of them. 

"We are prone in the modern time to think that 
our generation is the first to offer to women any 
facilities or opportunities for education in medicine. 
We are prone, however, just in the same way, to 
consider that a number of things that we are doing 
are now being done for the first time. As a matter 
of fact, it is extremely difficult to find any im 
portant movement or occupation that is not merely 
a repetition of a previous interest of mankind. The 
whole question of feminine education we are apt to 
think of as modern, forgetting that Plato insisted 
in his " Republic," as absolutely as any modern fem 
inist, that women should have the same opportuni 
ties for education as men, and that at Rome, at the 
end of the Republic and the beginning of the Em 
pire, the women occupied very much the same posi- 


tion in social life as our own at the present time. 

Their husbands supplied the funds, and they 
patronized the artists, gave receptions to the poets, 
lionized the musicians, and, in general, " went after 
culture " in a way that is a startling reminder of 
what we are familiar with in our own time. Just as 
soon as Christianity began to influence education, 
women were given abundant opportunities for 
higher education in all forms. In Ireland, the 
first nation completely converted to Christianity, 

where, therefore, the national policy in education 
could be shaped by the Church without hindrance, 
St. B rigid s school at Kildare was scarcely less 
famous than St. Patrick s at Armagh. It had sev 
eral thousand students, and, to a certain extent at 
least, co-education existed. In Charlemagne s time, 
with the revival of education on the Continent, the 
women of the Imperial Court attended the Palace 
School, as well as the men. In the thirteenth cen 
tury we find women professors in every branch at 
Italian universities. Some of them were at least 
assistants in anatomy. The Renaissance women 
were, of course, profoundly educated. In a word, 
we have many phases of feminine education, though 
with intervals of absolutely negative interest, down 
the centuries. 

There had evidently been quite a considerable 
amount of opportunity, if not of actual encourage 
ment, for women in medicine, both among the Greeks 
and the Romans, in the early centuries of the Chris 
tian era. Galen, for instance, quotes certain pre 
scriptions from women physicians. One Cleopatra 
is said to have written a book on cosmetics. This 


name caine afterwards to be confounded with that 
of Queen Cleopatra, giving new prestige to the book, 
but neither Galen nor Aetius, the early Christian 
physician, both of whom quote from her work, speak 
of her as anything except a medical writer. Some 
monuments to women physicians from these old 
times have escaped the tooth of time. There was 
the tomb of one Basila, and also of a Thecla, both of 
whom are said to have been physicians. Two other 
names of Greek women physicians we have, Origenia 
and Aspasia, the former mentioned by Galen, the 
latter by Ae tius in his " Tetrabiblion." Darem- 
berg, the medical historian, announced in 1851 that 
he had found a Greek manuscript with the title, " On 
Women s Diseases," written by one Metrodora, a 
woman physician. He promised to publish it. It 
was unpublished at the time of his death, but could 
not be found among his papers. There is a manu 
script on medical subjects, bearing this name, men 
tioned in the catalogue of the Greek Codices of 
the Laurentian Library at Florence, but this is said 
to give no indication of the time when its author 
lived. We have evidence enough, however, to show 
that Greek women physicians were not very rare. 

The Romans imitated the Greeks so faithfully 
one might almost say copied them so closely that it 
is not surprising to find a number of Roman women 
physicians. The first mention of them comes from 
Scribonius Largus, in the first century after Christ. 
Octavius Horatianus, whom most of us know better 
as Priscian, dedicated one of his books on medicine 
to a woman physician named Victoria. The dedica 
tion leaves no doubt that she was a woman in active 


practice, at least in women s diseases, and it is a 
book on this subject that Priscian dedicates to her. 
He mentions another woman physician, Leoparda. 
The word medico, for a woman physician was very 
commonly used at Rome. Martial, whose epigrams 
have been a source of so much information in med 
ical history, especially on subjects with regard to 
which information was scanty, mentions a medica 
in an epigram. Apuleius also uses the word. There 
are a number of inscriptions in which women physi 
cians are mentioned. Among the Christians we find 
women physicians, and Theodosia, the mother of St. 
Procopius, the martyr, is said to have been very 
successful in the practice of both medicine and 
surgery. She is numbered among the martyrs, and 
occurs in the Roman Martyrology on the 29th of 
May. Father Bzowski, the Polish Jesuit, who com 
piled " Nomenclatura Sanctorum Professione Medi- 
corum " (Rome, 1621 ; the book is usually catalogued 
under the Latin form of his name, Bzovius), has 
among his list of saints who were physicians by 
profession a woman, St. Nicerata, who lived at Con 
stantinople in the reign of the Emperor Arcadius, 
and who is said to have cured St. John Chrysostom 
of a serious disease. 

The organization of the department of women s 
diseases at Salerno, under the care of women pro 
fessors, and the granting of licenses to women to 
practise medicine, is not so surprising in the light 
of this tradition among Greeks and Romans, taken 
up with some enthusiasm by the Christians. We 
are not sure just when this development took place. 
The first definite evidence with regard to it comes 


in the life of Trotula, who seems to have been the 
head of the department. Some of her books are 
well known, and often quoted from, and she con 
tributed to a symposium on the treatment of disease, 
in which there are contributions, also, from men 
professors of Salerno at the time. She seems to 
have flourished about the middle of the eleventh 
century. Ordericus Vitalis, a monk of Utica, who 
wrote an ecclesiastical history, tells of one Kudolph 
Malcorona, who, in 1059, came to Utica and re 
mained there for a long time with Father Eobert, 
his nephew. " This Rudolph had been a student 
all his life, devoting himself with great zeal to 
letters, and had become famous for his visits to the 
schools of France and Italy, in order to gather there 
the secrets of learning. As a consequence he was 
well informed not only in grammar and dialectics, 
but also in astronomy and in music. He also pos 
sessed such an extensive knowledge of the natural 
sciences that in the town of Salerno, where, since 
ancient times, the best schools of medicine had ex 
isted, there was no one to equal him with the ex 
ception of a very wise matron." 

This wise matron has been identified with Tro 
tula, many of the details of whose life have been 
brought to light by De Renzi, in his " Story of the 
School of Salerno." 1 According to very old tradi 
tion, Trotula belonged to the family of Ruggiero. 
This was a noble family of Salerno, many of the 
members of which were distinguished in their native 
town at least, but the name is not unusual in Italy, 

^ Storia de la Scuola di Salerno." 


as readers of Dante and Boccaccio are likely to 
know. It was, indeed, as common as our own 
Rogers, of which it is the Italian equivalent. 

De Renzi has made out a rather good case for the 
tradition that Trotula was the wife of John 
Platearius I so called because there were probably 
three professors of that name. Trotula was, ac 
cording to this, the mother of the second Platearius, 
and the grandmother of the third, all of them dis 
tinguished members of the faculty at Salerno. 

Her reputation extended far beyond her native 
town, and even Italy itself, and, in later centuries, 
her name was used to dignify any form of treat 
ment for women s diseases that was being exploited. 
Rutebeuf, one of the trouveres, thirteenth-century 
French poets, has a description of the scene in 
which one of the old herbalist doctors who used to 
go round and collect a crowd by means of songs 
and music, and then talk medicine to them just as 
is done even yet in many of the smaller towns of 
this country is represented as saying to the crowd 
when he wants to make them realize that he is no 
ordinary quacksalver, that he is one of the disciples 
of the great Madame Trot of Salerno. The old- 
fashioned speech runs somewhat as follows: 
" Charming people: I am not one of these poor 
preachers, nor the poor herbalists, who carry little 
boxes and sachets, and who spread out before them 
a carpet. I am the disciple of a great lady, who 
bears the name of Madame Trot of Salerno. And 
I would have you know that she is the wisest woman 
in all the four quarters of the world." 

Two books are attributed to Trotula; one bears 


the title, " De Passionibus Mulierum," and the other 
has been called " Trotula Minor," or " Summula 
Secundum Trotulam," and is a compendium of what 
she wrote. This is probably due to some disciple, 
but seems to have existed almost in her own time. 
Her most important work bears two sub-titles, 
" Trotula s Unique Book for the Curing of Diseases 
of Women, Before, During, and After Labor," and 
the other sub-title, " Trotula s Wonderful Book of 
Experience (experiment alts) in the Diseases of 
Women, Before, During, and After Labor, with 
Other Details Likewise Eclating to Labor." 

The book begins with a prologue on the nature 
of man and of woman, and an explanation of how 
the author, taking pity on the sufferings of women, 
came to devote herself to the study of their diseases. 
There are many interesting details in the book, all 
the more interesting because in many ways they an 
ticipate modern solutions of difficult problems in 
women s diseases, and the care of the mother and 
child before, during, and after labor. For instance, 
there are a series of rules on the choice of the nurse, 
and on the diet and the regime which she should 
follow if the child is to be properly nourished with 
out disturbance. 

Probably the most striking passage in her book 
is that with regard to a torn perineum and its re 
pair. This passage may be found in De Renzi or in 
Gurlt. It runs as follows : Certain patients, from 
the severity of the labor, run into a rupture of the 
genitalia. In some even the vulva and anus be 
come one foramen, having the same course. As a 
consequence, prolapse of the uterus occurs, and 


it becomes indurated. In order to relieve this con 
dition, we apply to the uterus warm wine in which 
butter has been boiled, and these fomentations are 
continued until the uterus becomes soft, and then it 
is gently replaced. After this the tear between the 
anus and vulva we sew in three or four places with 
silk thread. The woman should then be placed in 
bed, with the feet elevated, and must retain that 
position, even for eating and drinking, and all the 
necessities of life, for eight or nine days. During 
this time, also, there must be no bathing, and care 
must be taken to avoid everything that might cause 
coughing, and all indigestible materials." 

There is a passage, also, almost more interesting 
with regard to prophylaxis of rupture of the 
perineum. She says, " In order to avoid the afore 
said danger, careful provision should be made, and 
precautions should be taken during labor somewhat 
as follows: A cloth should be folded in somewhat 
oblong shape, and placed on the anus, so that, during 
every effort for the expulsion of the child, that 
should be pressed firmly, in order that there may 
not be any solution of the continuity of tissue." 

Her book contains, also, some directions for vari 
ous cosmetics. How many of these are original, 
however, is difficult to say. Trotula s name had be 
come a word to conjure with, and many a quack in 
the after time tried to make capital for his remedies 
in this line by attributing them to Trotula. As a 
consequence, many of these remedies gradually 
found their way into the manuscript copies of her 
book, and subsequent copyists incorporated them 
into the text, until it became practically impossible 


to determine which were original There are manu 
scripts of Trotula s work in Florence, Vienna, and 
Breslau. Some of these contain chapters not in 
the others, undoubtedly added by subsequent hands. 
In one of these, that at Florence, from which the edi 
tion of Strasburg was printed in 1544, and of Venice, 
1547, one of the Aldine issues, there is a mention in 
the last chapter of spectacles. We have no record 
of these until the end of the thirteenth century, 
when this passage was probably added. It was also 
printed at Basle, 1566, and at Leipzig as late as 
1778, which would serve to show how much atten 
tion it has attracted even in comparatively recent 

After Trotula we have a number of women physi 
cians of Salerno whose names have come down to us. 
The best known of these bear the names Constanza, 
Calendula, Abella, Mercuriade, Rebecca Guarna, who 
belonged to the old Salernitan family of that name, 
a member of which, in the twelfth century, was 
Eomuald, priest, physician, and historian, Louise 
Trencapilli, and others. The titles of some of their 
books, as those of Mercuriade, who occupied her 
self with surgery as well as medicine, and who is 
said to have written on " Crises," on " Pestilent 
Fever," on " The Cure of Wounds," and of Abella, 
who acquired a great reputation with her work on 
Black Bile," and on the " Nature of Seminal 
Fluid," have come down to us. Eebecca Guarna 
wrote on " Fevers," on the " Urine," and on the 
" Embryo." The school of Salernitan women 
came to have a definite place in medical literature. 

While, as teachers, they had charge of the depart- 


ment of women s diseases, their writings would seem 
to indicate that they studied all branches of medi 
cine. Besides, there are a number of licenses pre 
served in the archives of Naples in which women 
are accorded the privilege of practising medicine. 
Apparently these licenses were without limitation. 
In many of these mention is made of the fact that 
it seems especially fitting that women should be al 
lowed to practise in women s diseases, since they 
are by constitution likely to know more and to 
have more sympathy with feminine ills. The 
formula employed as the preamble of this license 
ran as follows: " Since, then, the law permits women 
to exercise the profession of physicians, and since, 
besides, due regard being had to purity of morals, 
women are better suited for the treatment of 
women s diseases, after having received the oath of 
fidelity, we permit, etc." 

Salerno continued to enjoy a reputation for train 
ing women physicians thoroughly, until well on in 
the fifteenth century, for we have the record of Con 
stance Calenda, the daughter of Salvator Calenda, 
who had been dean of the faculty of medicine at 
Salerno about 1415, and afterwards dean of the 
faculty at Naples. His daughter, under the diligent 
instruction of her father, seems to have obtained 
special honors for her medical examination. Not 
long after this, Salerno itself lost all the prestige 
that it had. The Kings of Naples endeavored to 
create a great university in their city in the thir 
teenth century. They did not succeed to the extent 
that they hoped, but the neighboring rival institution 
hurt Salerno very much, and its downfall may be 


traced from this time. Gradually its reputation 
waned, and we have practically no medical writer of 
distinction there at the end of the fourteenth cen 
tury, though the old custom of opportunities for 
women students of medicine was maintained. 

This custom seems also to have been transferred 
to Naples, and licenses to practise were issued to 
woman graduates of Naples. This never achieved 
anything like the reputation in this department that 
had heen attained at Salerno. Salerno influenced 
Bologna and the north Italian universities pro 
foundly in all branches of medicine and medical edu 
cation, particularly in surgery, as can be seen in 
the chapter on " Great Surgeons of the Medieval 
Universities," and the practice of allowing such 
women as wished to study medicine to enter the 
university medical schools is exemplified in the case 
of Mondino s assistant in anatomy, Alessandra 
Giliani, though there are also others whose names 
have come down to us. 

The University of Salerno had developed round 
a medical school. It was the first of the uni 
versities, and, in connection with its medical school, 
feminine education obtained a strong foothold. It 
is not surprising, then, that with the further de 
velopment of universities in Italy, feminine educa 
tion came to be the rule. This rule has maintained 
itself all down the centuries in Italy, so that there 
has not been a single century since the twelfth in 
which there have not been one or more distinguished 
women teachers at the Italian universities. Uni 
versity life gradually spread westward, and Paris 
came into existence as an organized institution of 


learning after Bologna, and, doubtless, with some 
of the traditions of Salerno in the minds of its 
founders. Feminine education, however, did not 
spread to the West. This is a little bit difficult to 
understand, considering the reverence that the Teu 
tonic peoples have always had for their women folk 
and the privileges accorded them. A single un 
fortunate incident, that of Abelard and Helo ise, 
seems to have been sufficient to discourage efforts 
in the direction of opportunities for feminine edu 
cation in connection with the Western universities. 
Perhaps, in the less sophisticated countries of the 
North and West of Europe, women did not so 
ardently desire educational opportunities as in Italy, 
for whenever they have really wanted them, as, 
indeed, anything else, they have always obtained 

In spite of the absence of formal opportunities 
for feminine education in medicine at the Western 
universities, a certain amount of scientific knowl 
edge of diseases, as well as valuable practical train 
ing in the care of the ailing, was not wanting for 
women outside of Italy. The medical knowledge of 
the women of northern France and Germany and 
England, however, though it did not receive the 
stamp of a formal degree from the university and 
the distinction of a license to practise, was none the 
less thorough and extensive. It came in connection 
with certain offices in their own communities, held 
by members of religious orders. Genuine informa 
tion with regard to what the religious were doing 
during the Middle Ages was so much obscured by 
the tradition of laziness and immorality, created at 


the time of the so-called reformation in order to 
justify the confiscation of their property by those 
whose one object was to enrich themselves, that we 
have only come to know the reality of their life and 
accomplishments in comparatively recent years. 
AVe now know that, besides being the home of most 
of the book knowledge of the earlier Middle Ages, 
the monasteries were the constant patrons of such 
practical subjects as architecture, agriculture in all 
its phases, especially irrigation, draining, and the 
improvement of land and crops; of art, and even 
what Ave now know as physical science. Above all, 
they preserved for us the old medical books and 
carried on medical traditions of practice. The 
greatest surprise has been to find that this was 
true not only for the monks, but also for the 

One of the most important books on medicine that 
has come to us from the twelfth century is that of a 
Benedictine abbess, since known as St. Hildegarde, 
whose life was spent in the Rhineland. Her works 
serve to show very well that in the convents of the 
tenth, eleventh, and twelfth centuries there was 
much more of interest in things intellectual than we 
have had any idea of until recent years, and that, 
indeed, one of the important occupations of convent 
life was the serious study of books of all kinds, some 
of them even scientific, as well as the writing of 
works in all departments. The century before St. 
Hildegarde there is the record of Hroswitha, who 
wrote a series of dramas in imitation of Terence, 
that were meant to replace, for the monks and nuns 
of that period, the reading of that rather too human 


author. Hroswitha, like Hildegarde, was a German, 
and we have the record, also, of another religious 
writer, abbess of the Odilian Cloister, at Hohenberg, 
who wrote a book called " Hortus Deliciarum, the 
Garden of Delights," a book of information on 
many subjects not unlike our popular encyclopedias 
of the modern time, the title of which shows that 
the place of information in life was considered to be 
the giving of pleasure. While this work deals 
mainly with Biblical and theological and mystical 
questions, there are many purely scientific passages 
and many subjects of strictly medical interest 

The life of the Abbess Hildegarde is worthy of 
consideration, because it illustrates the period and 
makes it very clear that, in spite of the grievous 
misunderstanding of their life and work, so com 
mon in the modern time, these old-time religious 
had most of the interests of the modern time, and 
pursued them with even more than modern zeal 
and success, very often. Her career illustrates 
very well what the foundation of the Benedictines 
had done for women. When St. Benedict founded 
his order for men, his sister, Scholastica, wanted 
to do a similar work for women. We know that 
the Benedictine monks saved the old classics for 
us, kept burning the light of the intellectual life, 
and gave a refuge to men who wanted to devote 
themselves in leisure and peace to the things of 
the spirit, whether of this world or the other. We 
have known much less of the Benedictine nuns un 
til now the study of their books shows that they 
provided exactly the same opportunities for women 


and furnished a vocation, a home, an occupation of 
mind, and a satisfaction of spirit for the women 
who, in every generation, do not feel themselves 
called to be wives and mothers, but who want to 
live their lives for others rather than for them 
selves and their kin, seeking such development of 
mind and of spirit as may come with the leisure and 
peace of celibacy. 

Hildegarde was born of noble parents at Bockel- 
heim, in the county of Sponheim, about the end of 
the eleventh century (probably 1098). In her eighth 
year she went for her education to the Benedictine 
cloister of Disibodenberg. When her education was 
finished, she entered the cloister, of which, at the age 
of about fifty, she became abbess. Her writings, 
reputation for sanctity, and her wise saintly rule 
attracted so many new members to the community 
that the convent became overcrowded. Accord 
ingly, with eighteen of her nuns, Hildegarde with 
drew to a new convent at Rupertsberg, which Eng 
lish and American travellers will remember because 
it is not far from Bingen on the Rhine. Here she 
came to be a centre of attraction for most of the 
world of her time. She was in active correspond 
ence with nearly every important man of her gen 
eration. She was an intimate friend of Bernard of 
Clairvaux, who was himself, perhaps, the most in 
fluential man in Europe in this century. She was in 
correspondence with four Popes, and with the Em 
perors Conrad and Frederick I, and with many dis 
tinguished archbishops, abbots, and abbesses, and 
teachers and teaching bodies of various kinds. These 
correspondences were usually begun by her corre- 


spondents, who consulted her because her advice 
in difficult problems was considered so valu 

In spite of all this time-taking correspondence, 
she found leisure to write a series of books, most 
of them on mystical subjects, but two of them on 
medical subjects. The first is called " Liber Sim- 
plicis Medicinse," and the second " Liber Composite 
Medicinae. " These books were written in order to 
provide information mainly for the nuns who had 
charge of the infirmaries of the monasteries of the 
Benedictines. Almost constantly someone in the 
large communities, which always contained aged re 
ligious, was ailing, and then, besides, there were 
other calls on the time and the skill of the sister 
infirmarians. There were no hotels at that time, 
and no hospitals, except in the large cities. There 
were always guest houses in connection with 
monasteries and convents, in which travellers were 
permitted to pass the night, and given what they 
needed to eat. There are many people who have 
had experiences of monastic hospitality even in our 
own time. Sometimes travellers fell ill. Not in 
frequently the reason for travelling was to find 
health in some distant and fabulously health-giving 
resort, or at the hands of some wonder-working 
physician. Such high hopes are nearly always set 
at a distance. This of itself must have given not 
a little additional need for knowledge of medicine 
to the infirmarians of convents and monasteries. 
There were around many of the monasteries, more 
over, large estates ; often they had been cleared and 
made valuable by the work of preceding genera- 


tions of monks, and on these estates peasants came 
to live. "\Yorkingmen and workingwomen from 
neighboring districts came to help at harvest time, 
and, after a chance meeting, were married and 
settled down on a little plot of ground provided 
for them near the monastery. As these communi 
ties grew up, they looked to the monasteries and 
convents for aid of all kinds, and turned to them 
particularly in times of illness. The need for 
definite instruction in medicine on the part of a 
great many of the monks and nuns can be readily 
understood, and it was this need that Hildegarde 
tried to meet in her books. The first of her books 
that we have mentioned, the " Liber Simplicis 
Medicines," attracted attention rather early in the 
Renaissance, and was deemed worthy of print. It 
was edited at the beginning of the sixteenth century 
by Dr. Schott at Strasburg, under the title, 
" Physica S. Hildegardis." Another manuscript 
of this part was found in the library of Wolfenbut- 
tel, in 1858, by Dr. Jessen. This gave him an in 
terest in Hildegarde s contributions to medicine, 
and, in 1859, he noted in the library at Copenhagen 
a manuscript with the title " Hildegardi Curae et 
Causae." On examination, he was sure that it was 
the " Liber Composite Medicinae " of the saint. 
The first work consists of nine books, treating of 
plants, elements, trees, stones, fishes, birds, 
quadrupeds, reptiles, and metals, and is printed in 
Migne s " Patrologia," under the title " Subtilita- 
tum Diversarum Naturarum Libri Novem." The 
second, in five books, treats of the general diseases 
of created things, of the human body and its ail- 


ments, of the causes, symptoms, and treatment of 

It would be very easy to think that these are small 
volumes and that they contain very little. We are 
so apt to think of old-fashioned so-called books as 
scarcely more than chapters, that it may be interest 
ing to give some idea of the contents and extent of 
the first of these works. The first book on Plants 
has 230 chapters, the second on the Elements has 
13 chapters, the third on Trees has 36 chapters, the 
fourth on various kinds of Minerals, including pre 
cious stones, has 226 chapters, the fifth on Fishes 
has 36 chapters, the sixth on Birds has 68 chapters, 
the seventh on Quadrupeds has 43 chapters, the 
eighth on Reptiles has 18 chapters, the ninth on 
Metals has 8 chapters. Each chapter begins with 
a description of the species in question, and then 
defines its value for man and its therapeutic sig 
nificance. Modern scientists have not hesitated to 
declare that the descriptions abound in observa 
tions worthy of a scientific inquiring spirit. We 
are, of course, not absolutely sure that all the con 
tents of the books come from Hildegarde. Subse 
quent students often made notes in these manuscript 
books, and then other copyists copied these into 
the texts. Unfortunately we have not a number of 
codices to collate and correct such errors. Most 
of what Hildegarde wrote comes to us in a single 
copy, of none are there more than four copies, show 
ing how near we came to missing all knowledge of 
her entirely. 

Dr. Melanie Lipinska, in her " Histoire des 
Femmes Medecins," a thesis presented for the doc- 


torate in medicine at the University of Paris in 
1900, subsequently awarded a special prize by the 
French Academy, reviews Hildegarde s work 
critically from the medical standpoint. She says 
that the saint distinguishes a double mode of action 
of different substances, one chemical, the other phys 
ical, or what we would very probably call magnetic. 
She discusses all the ailments of the various organs, 
the brain, the eyes, the teeth, the heart, the spleen, 
the stomach, the liver. She has special chapters on 
redness and paleness of the face, on asthma, on 
cough, on fetid breath, on bilious indigestion, on 
gout. Besides, she has other chapters on nervous 
affections, on icterus, on fevers, on intestinal worms, 
on infections due to swamp exhalations, on dysen 
tery, and a number of forms of pulmonary diseases. 
Nearly all of our methods of diagnosis are to be 
found, hinted at at least, in her book. She dis 
cusses the redness of the blood as a sign of health, 
the characteristics of various excrementitious mate 
rial as signs of disease, the degrees of fever, 
and the changes in the pulse. Of course, it was 
changes in the humors of the body that constituted 
the main causes for disease in her opinion, but it is 
well to remind ourselves that our frequent dis 
cussion of auto-intoxication in recent years is a dis 
tinct return to this. 

Some of Hildegarde s anticipations of modern 
ideas are, indeed, surprising enough. For instance, 
in talking about the stars and describing their 
course through the firmament, she makes use of a 
comparison that is rather startling. She says: 
" Just as the blood moves in the veins which causes 


them to vibrate and pulsate, so the stars move in 
the firmament and send out sparks as it were of 
light like the vibrations of the veins." This is, of 
course, not an anticipation of the discovery of the 
circulation of the blood, but it shows how close were 
men s ideas to some such thought five centuries be 
fore Harvey s discovery. For Hildegarde the brain 
was the regulator of all the vital qualities, the centre 
of life. She connects the nerves in their passage 
from the brain and the spinal cord through the body 
with manifestations of life. She has a series of 
chapters with regard to psychology normal and 
morbid. She talks about frenzy, insanity, despair, 
dread, obsession, anger, idiocy, and innocency. 
She says very strongly in one place that " when 
headache and migraine and vertigo attack a patient 
simultaneously they render a man foolish and up 
set his reason. This makes many people think that 
he is possessed of a demon, but that is not true." 
These are the exact words of the saint as quoted in 
Mile. Lipinska s thesis. 

It is no wonder that Mile. Lipinska thinks St. 
Hildegarde the most important medical writer of her 
time. Eeuss, the editor of the edition of Hilde 
garde published in Migne s " Patrology," says: 
" Among all the saintly religious who have prac 
tised medicine or written about it in the Middle 
Ages, the most important is without any doubt St. 
Hildegarde. . . . With regard to her book he 
says : All those who wish to write the history of 
the medical and natural sciences must read this work 
in which this religious woman, evidently well 
grounded in all that was known at that time in the 


secrets of nature, discusses and examines carefully 
all the knowledge of the time." He adds, "It is 
certain that St. Hildegarde knew many things that 
were unknown to the physicians of her time." 

When such books were read and widely copied, it 
shows that there was an interest in practical and 
scientific medicine among women in Germany much 
greater than is usually thought to have existed at 
this time. Such writers, though geniuses, and 
standing above their contemporaries, usually repre 
sent the spirit of their times and make it clear that 
definite knowledge of things medical was consid 
ered of value. The convents and monasteries of 
this time are often thought of by those who know 
least about them as little interested in anything 
except their own ease and certain superstitious prac 
tices. As a matter of fact, they cared for their 
estates, and especially for the peasantry on them, 
they provided lodging and food for travellers, they 
took care of the ailing of their neighborhood, and, 
besides, occupied themselves with many phases of 
the intellectual life. It was a well-known tradition 
that country people who lived in the neighborhood of 
convents and monasteries, and especially those who 
had monks and nuns for their landlords, were much 
happier and were much better taken care of than 
the tenantry of other estates. For this a cultiva 
tion of medical knowledge was necessary in certain, 
at least, of the members of the religious orders, and 
such books as Hildegarde s are the evidence that 
not only the knowledge existed, but that it was col 
lected and written down, and widely disseminated. 

Nicaise, in the introduction to his edition of 


Guy de Chauliac s " Grande Chirurgie," reviews 
briefly the history of women in medicine, and con 
cludes : 

" Women continued to practise medicine in Italy 
for centuries, and the names of some who attained 
great renown have been preserved for us. Their 
works are still quoted from in the fifteenth century. 

" There was none of them in France who became 
distinguished, but women could practise medicine in 
certain towns at least on condition of passing an 
examination before regularly appointed masters. 
An edict of 1311, at the same time that it interdicts 
unauthorized women from practising surgery, recog 
nizes their right to practise the art if they have 
undergone an examination before the regularly ap 
pointed master surgeons of the corporation of Paris. 
An edict of King John, April, 1352, contains the 
same expressions as the previous edict. Du Bouley, 
in his History of the University of Paris, gives 
another edict by the same King, also published in 
the year 1352, as a result of the complaints of the 
faculties at Paris, in which there is also question 
of women physicians. This responded to the peti 
tion : Having heard the petition of the Dean and 
the Masters of the Faculty of Medicine at the Uni 
versity of Paris, who declare that there are very 
many of both sexes, some of the women with legal 
title to practise and some of them merely old pre 
tenders to a knowledge of medicine, who come to 
Paris in order to practise, be it enacted, etc. (The 
edict then proceeds to repeat the terms of previous 
legislation in this matter.) 

" Guy de Chauliac speaks also of women who 
practised surgery. They formed the fifth and last 
class of operators in his time. He complains that 
they are accustomed to too great an extent to give 
over patients suffering from all kinds of maladies 


to the will of Heaven, founding their practice on 
the maxim The Lord has given as he has pleased ; 
the Lord will take away when he pleases; may the 
name of the Lord be blessed. 

" In the sixteenth century, according to Pasquier, 
the practice of medicine by women almost entirely 
disappeared. The number of women physicians be 
comes more and more rare in the following centuries 
just in proportion as we approach our own time. 
Pasquier says that we find a certain number of them 
anxious for knowledge and with a special penchant 
for the study of the natural sciences and even of 
medicine, but very few of them take up practice." 

Just how the lack of interest in medical education 
for women gradually deepened, until there was al 
most a negative phase of it, only a few women in 
Italy devoting themselves to medicine, is hard to 
say. It is one of the mysteries of the vicissitudes 
of human affairs that ups and downs of interest in 
things practical as well as intellectual keep con 
stantly occurring. The number of discoveries and 
inventions in medicine and surgery that we have 
neglected until they were forgotten, and then had 
to make again, is so well illustrated in chapters of 
this book, that I need only recall them here in gen 
eral. It may seem a little harder to understand 
that so important a manifestation of interest in 
human affairs as the education and licensure of 
women physicians should not only cease, but pass 
entirely out of men s memory, yet such apparently 
was the case. It would not be hard to illustrate, as 
I have shown in " Cycles of Feminine Education 
and Influence " in " Education, How Old the New " 
(Fordham University Press, 1910), that corre- 


spending ups and downs of interest may be traced in 
the history of feminine education of every kind. 
In that chapter I have discussed the possible rea 
sons for these vicissitudes, which have no place here, 
but I may refer those who are interested in the 
subject to that treatment of it. 




The most important contributions to medical sci 
ence made by the Medical School of Salerno at the 
height of its development were in surgery. The 
text-books written by men trained in her halls or 
inspired by her teachers were to influence many 
succeeding generations of surgeons for centuries. 
Salerno s greatest legacy to Bologna was the group 
of distinguished surgical teachers whose text-books 
we have reviewed in the chapter, " Great Surgeons 
of the Medieval Universities." Bologna herself was 
to win a place in medical history, however, mainly in 
connection with anatomy, and it was in this depart 
ment that she was to provide incentive especially 
for her sister universities of north Italy, though 
also for "\Yestern Europe generally. The first 
manual of dissection, that is, the first handy volume 
giving explicit directions for the dissection of human 
cadavers, was written at Bologna. This was scat 
tered in thousands of copies in manuscript all over 
the medical world of the fourteenth and early fif 
teenth centuries. Even after the invention of print 
ing, many editions of it were printed. Down to the 
sixteenth century it continued to be the most used 
text-book of anatomy, as well as manual of dissec 
tion, which students of every university had in hand 



when they made their dissection, or wished to pre 
pare for making it, or desired to review it after the 
body had been taken away, for with lack of proper 
preservative preparation, bodies had to be removed 
in a comparatively short time. Probably no man 
more influenced the medical teaching of the four 
teenth and fifteen centuries than Mundinus, or, as 
he was called in the Italian fashion, Mondino, who 
wrote this manual of dissection. 

Mundinus quern omnis studentium universitas 
colit ut deum (Mundinus, whom all the world of stu 
dents cultivated as a god), is the expression by 
which the German scholar who edited, about 1500, 
the Leipzig edition of Mundinus well-known 
manual, the Anathomia, introduces it to his readers. 
The expression is well worth noting, because it 
shows what was still the reputation of Mundinus in 
the medical educational world nearly two centuries 
after his death. 1 

Until the time of Vesalius, whose influence was 
exerted about the middle of the sixteenth century, 
Mondino was looked up to by all teachers as 
the most important contributor to the science of 

1 It is probably interesting to note that the word universitas as used 
here has no reference to our word university, but refers to the whole 
world of students as it were. In the Middle Ages universities were 
called studio, gentralia, general studies that is, places where everything 
could be studied and where everyone from any part of the world could 
study. Our use of the word university in the special modern sense 
of the term comes from the formal mode of address to the faculty of a 
university when Popes or rulers sent them authoritative documents. 
Such documents began with the expression Universitas vestra, all of 
you (in the old-time English, as preserved in the Irish expression, " the 
whole of ye"), referring to all the members of the faculty. The transfer 
to our term and signification university was not difficult. 


anatomy in European medicine since the Greeks. 
He owed his reputation to two things : his book, of 
which we have already spoken, and then, the fact 
that he reintroduced dissection demonstrations as 
a regular practice in the medical schools. His book 
is really a manual of making anatomical prepara 
tions for demonstration purposes. These demon 
strations had to be hurried, owing to the rapid de 
composition of material consequent upon the lack 
of preservatives. The various chapters were pre 
pared with the idea of supplying explicit directions 
and practical help during the anatomical demonstra 
tions, so that these might be made as speedily as 
possible. The book does not comprise much that 
was new at that time, but it is a good compendium of 
previous knowledge, and contains some original ob 
servations. It was entirely owing to its form as a 
handy manual of anatomical knowledge and, besides, 
because it was an incentive to the practice of human 
dissection, that it attained and maintained its pop 

Moudino followed Galen, of course, and so did 
every other teacher in medicine and its allied sci 
ences, until Vesalius time. Even Vesalius permit 
ted himself to be influenced overmuch by Galen at 
points where we wonder that he did not make his 
observations for himself, since, apparently, they 
were so obvious. The more we know of Galen, 
however, the less surprised are we at his hold over 
the minds of men. Only those who are ignorant of 
Galen s immense knowledge, his practical common 
sense, and the frequent marvellous anticipations of 
what we think most modern, affect to despise him. 


His works have never been translated into any 
modern language except piecemeal, there is no com 
plete translation, and one must be ready to delve 
into some large Latin, if not Greek, volumes to 
know what a marvel of medical knowledge he was, 
and how wise were the men who followed him 
closely, though, being human, there are times when 
necessarily he failed them. 

For those who know even a little at first hand of 
Galen, it is only what might be expected, then, that 
Mondino, trying to break away from the anatomy 
of the pig, which had been before this the basis of all 
anatomical teaching in the medical schools (Copho s 
book, used at Salerno and Bologna before Mondino s 
was founded on dissections of the pig), should have 
clung somewhat too closely to this old Greek teacher 
and Greek master. The incentive furnished by 
Mondino s book helped to break the tradition of 
Galen s unquestioned authority. Besides this, the 
group of men around Mondino, his master, Taddeo 
Alderotti, with his disciples and assistants, form 
the initial chapter in the history of the medical 
school of Bologna, which gradually assumed the 
place of Salerno at this time. There is no better 
way of getting a definite idea of what was being done 
in medicine, and how it was being done, than by 
knowing some of the details of the life of this 
group of medical workers. 

Mondino di Liucci, or Luzzi, is usually said to 
have been born about 1275. His first name is a 
diminutive for Baimondo. It used to be said of 
him that, like many of the great men of history, 
many cities claimed to be his birthplace. Five were 


particularly mentioned Florence, Milan, Bologna, 
Forli, and Friuli. There is, however, another Mon- 
dino, a distinguished physician, who was born and 
lived at Friuli, and it is because of confusion with 
him that the claim for Friuli has been set up. 
Florence and Milan are considered out of the ques 
tion. Mondino was probably born in or near Bo 
logna. The fact that there should have been this 
multiple set of claims shows how much was thought 
of him. Indeed, his was the best known name in the 
medical schools of Europe for nearly two centuries 
and a half. He seems to have been a particularly 
brilliant student, for tradition records that he had 
obtained his degree of doctor of medicine when he 
was scarcely more than twenty. This seems quite 
out of the question for us at the present time, but 
we have taken to pushing back the time of gradua 
tion, and it is not sure whether this is, beyond 
peraclventure, so beneficial as is usually thought. 

That his early graduation did not hamper his in 
tellectual development, the fact that, in 1306, when 
he was about thirty-one years of age, he was offered 
the professorial chair in anatomy, which he con 
tinued to occupy with such distinction for the next 
twenty years, would seem to prove. His public dis 
sections of human bodies, probably the first thus 
regularly made, attracted widespread attention, and 
students came to him not only from all over Italy, 
but also from Europe generally. In this, after all, 
Mondino was only continuing the tradition of world 
teaching that Bologna had acquired under her great 
surgeons in the preceding century. (See " Great 
Surgeons of the Medieval Universities.") 


Mondino came from a family that had already dis 
tinguished itself in medicine at Bologna. His uncle 
was a professor of physic at the university. His 
father, Albizzo di Luzzi, seems to have come from 
Florence not long after the middle of the thirteenth 
century, for the records show that, about 1270, he 
formed a partnership with one Bartolommeo Raineri 
for the establishment of a pharmacy at Bologna. 
Later this passed entirely under the control of the 
Mondino family, and came to be known as the 
Spezieria del Mondino. In it were sold, besides 
Eastern perfumes, spices, condiments, probably all 
sorts of toilet articles, and even rugs and silks and 
feminine ornaments. The stricter pharmacy of the 
earlier times developed into a sort of department 
store, something like our own. The Mondini, how 
ever, insisted always on the pharmacy feature as a 
specialty, and the fact was made patent to the gen 
eral public by a sign with the picture of a doctor on 
it. This drug shop of the Mondini continued to be 
maintained as such, according to Dr. Pilcher, until 
the beginning of the nineteenth century. 1 

One of the fellow students of Mondino at the Uni 
versity of Bologna had been Mondeville. He came 
from distant France to take a course in surgery with 

1 Physicians wore a particular garb consisting of a cloak and often 
a mask, supposed to protect them from infections at this time, so 
that it was not difficult to make a characteristic picture as a sign for 
a pharmacy. These symbolic signs were much commoner and very 
necessary when people generally were not able to read. It is from 
that period that we have the mortar and pestle as also the colored 
lights in the windows of the drug stores, and the many-colored 
barber-pole. Also the big boot, key, watch, hat, bonnet, and the 
like, the last symbolic sign invention apparently being the wooden 
Indian for the tobacco store. 


Theodoric, whose high reputation in the olden time, 
vague with us half a century ago, is now amply 
justified by what we know of him from such ardent 
students and admirers as Pagel and Nicaise. Not 
long after Mondino s death, Guy de Chauliac came 
from France to reap similar opportunities to these, 
which had proved so fruitful for Mondeville. The 
more that we learn about this time the more do we 
find to make it clear how deeply interested the gen 
eration was in education in every form, artistic, 
philosophic, but, also, though this is often not 
realized, scientific. 

The long distances, so much longer in that time 
than in ours, to which men were willing, and even 
anxious, to go, in order to obtain opportunities for 
research, and to get in touch with a special master, 
the associations with stimulating fellow pupils of 
other lands, the scientific correspondences, almost 
necessarily initiated by such circumstances, all in 
dicate an enthusiasm for knowledge such as we have 
not been accustomed to attribute to this period. On 
the contrary, we have been rather inclined to think 
them neglectful of all education, and have, above all, 
listened acquiescently while men deprecated the 
lack of interest in things scientific displayed by 
these generations. Indeed, many writers have gone 
out of their way to find a reason for the supposed 
lack of interest in science at this time, and have 
proclaimed the Church s opposition to scientific edu 
cation and study as the cause. 

At this time Italy was the home of the graduate 
teaching for all Europe. The Italian Peninsula con 
tinued to be the foster-mother of the higher educa- 


tion in letters and art, but also, though this is less 
generally known, in science, for the next five cen 
turies. Germany has come to be the place of pil 
grimage for those who want higher opportunities 
in science than can be afforded in their own coun 
try only during the latter half of the nineteenth 
century. France occupied it during the first half 
of the nineteenth century. Except for short inter 
vals, when political troubles disturbed Italy, as 
about the middle of the fourteenth century, when 
the removal of the Popes to Avignon brought their 
influence for education over to France and a short 
period at the beginning of the eighteenth century, 
when the Netherlands for a time came into educa 
tional prominence, Italy has always been the 
European Mecca for advanced students. Prac 
tically all our great discoverers in medicine, until 
the last century, were either Italians, or else had 
studied in Italy. Mondino, Bertrucci, Salicet, Lan- 
franc, Baverius, Berengarius, John De Vigo, who 
first wrote on gun-shot wounds ; John of Arcoli, first 
to mention gold filling and other anticipations of 
modern dentistry; Varolius, Eustachius, Caesal- 
pinus, Columbus, Malpighi, Lancisi, Morgagni, Spal- 
lanzani, Galvani, Volta, were all Italians. Monde- 
ville, Guy de Chauliac, Linacre, Vesalius, Harvey, 
Steno, and many others who might be named, all 
studied in Italy, and secured their best opportunities 
to do their great work there. 

It would be amusing, if it were not amazing, to 
have serious writers of history in the light of this 
plain story of graduate teaching of science in Italy 
for over five centuries, write about the opposition of 


the Church to science during the Medieval and 
Renaissance periods. It is particularly surprising 
to have them talk of Church opposition to the med 
ical sciences. The universities of the world all had 
their charters from the Popes at this time, and were 
all ruled by ecclesiastics, and most of the students 
and practically all of the professors down to the 
end of the sixteenth century belonged to the clerical 
order. The universities of Italy were all more di 
rectly under the control of ecclesiastical authority 
than anywhere else, and nearly all of them were 
dominated by papal influence. Bologna, while do 
ing much of the best graduate work in science, espe 
cially in medicine, was, in the Papal States, abso 
lutely under the rule of the Popes. The university 
was, practically, a department of the Papal govern 
ment. The medical school at the University of 
Rome itself was for several centuries, at the end of 
the Middle Ages, the teaching-place where were as 
sembled the pick of the great medical investigators, 
who, having reached distinction by their discoveries 
elsewhere, were summoned to Rome in order to add 
prestige to the Papal University. All of them be 
came special friends of the Popes, dedicated their 
books to them, and evidently looked to them as 
beneficent patrons and hearty encouragers of 
original scientific research. 

While this is so strikingly true of medical science 
as to make contrary declarations in the matter ut 
terly ridiculous, and to suggest at once that there 
must be some motive for seeing things so different 
to the reality, the same story can be told of graduate 
science in other departments. It was to Italv that 


men came for special higher studies in mathematics 
and astronomy, in botany, in mineralogy, and in ap 
plied chemistry, so far as it related to the arts of 
painting, illuminating, stained-glass making, and the 
like. No student of science felt that he had quite 
exhausted the opportunities for study that were pos 
sible for him until he had been down in Italy for 
some time. To meet the great professors in Italy 
was looked on as sure to be a source of special in 
centive in any department of science. This is com 
ing to be generally recognized just in proportion 
as our own interest in the arts and crafts, and in 
the history of science, leads us to go carefully into 
the details of these subjects at first hand. The 
editors of the " Cambridge Modern History," in 
their preface, declared ten years ago that we can 
no longer accept with confidence the declaration of 
any secondary writer on history. This is par 
ticularly true of the medieval period. We must go 
back to the writers of those times. 

If it seems surprising that the University of Bo 
logna should have come into such great prominence 
as an institute for higher education at this time, it 
would be well to recall some of the great work that 
is being done in this part of Italy in other depart 
ments at this time. Cimabue laid the foundation of 
modern art towards the end of the thirteenth cen 
tury, and during Mondino s life Giotto, his pupil, 
raised an artistic structure that is the admiration 
of all generations of artists since. Dante s years 
are almost exactly contemporary with those of 
Giotto and of Mondino. If men were doing such 
wondrous work in literature and in art, why should 


not the same generation produce a man who will ac 
complish for the practical science of medicine what 
his friends and contemporaries had done in other 
great intellectual departments. 

In recent years we have come to think much more 
of environment as an influence in human develop 
ment and accomplishment than was the custom some 
time ago. The broader general environment in 
Italy, with genius at work in other departments, was 
certainly enough to arouse in younger minds all 
their powers of original work. The narrower en 
vironment at Bologna itself was quite as stimulat 
ing, for a great clinical teacher, Taddeo Alderotti, 
had come, in 1260, from Florence to Bologna, to take 
up there the practice and teaching of medicine. It 
was under him that Mondino was to be trained for 
his life work. 

To understand the place of Mondino, and of the 
medical school of Bologna, in his time, and the repu 
tation that came to them as world teachers of medi 
cine, we must know, first, this great teacher of Mon 
dino and the atmosphere of progressive medicine 
that enveloped the university in the latter half of 
the thirteenth century. In the chapter on " Great 
Surgeons of the Medieval Universities " we call par 
ticular attention to the series of distinguished men, 
the first four of whom were educated at Salerno, and 
who came to Bologna to teach surgery. They were 
doing the best surgery in the world, much better 
than was done in many centuries after their time; 
indeed, probably better than at any period down to 
our own day. Besides, they seem to have been mag 
netic teachers who attracted and inspired pupils. 


We have the surgical contributions of a series of 
men, written at Bologna, that serve to show what 
fine work was accomplished. At this time, however, 
the field of medicine was not neglected, though we 
have but a single great historical name in it that has 
lived. This was Taddeo Alderotti, a man who lifted 
the medical profession as high in the estimation of 
his fellow citizens at Florence as the great painters 
and literary men of his time did their depart 
ments, and who then moved to Bologna, because of 
the opportunity to teach afforded him by the uni 

It is sometimes a little difficult for casual students 
of the time to understand the marvellous repu 
tation acquired by this medieval physician. It 
should not be, however, when we recall the enthusi 
astic reception and procession of welcome accorded 
to Cimabue s Madonna, and the almost universal 
acclaim of the greatness of Dante s work, even in 
his own time. In something of that same spirit Bo 
logna came to appreciate Taddeo, as he is familiarly 
known, looked upon him as a benefactor of the com 
munity, and voted to relieve him of the burden of 
paying taxes. He came to be considered as a pub 
lic institution, whose presence was a blessing to his 
fellow citizens, and whose goodness to them should 
be recognized in this public way. One is not sur 
prised to hear Villani, the well-known contemporary 
historian, speak of him as the greatest physician in 

The feelings of the citizens of Bologna, it may 
well be confessed, were not entirely unselfish, or 
due solely to the desire to encourage a great sci- 


entific genius. Few men of his generation had done 
more for the city in a material way quite apart from 
whatever benefits he conferred upon the health of 
its citizens than Dr. Taddeo. It was he who or 
ganized medical teaching in the city on such a plane 
that it attracted students from all over the world. 
Bologna had had a great law school before this, 
founded by Irnerius, to which students had come 
from all over the world. With the advent of Tad 
deo from Florence, and his success as a medical 
practitioner, there began to flock to his lectures 
many students who spread his fame far and wide. 
The city council could scarcely do less than grant the 
same privileges to the medical students and teachers 
of Taddeo s school as they had previously accorded 
to the faculty of law and its students. The city 
council recognized quite as clearly as any board of 
aldermen in the modern time how much, even of 
material benefit, a great university was to the build 
ing up of a city, though their motives were prob 
ably much higher than that, and their enlightened 
policy had its reward in the rapid growth of Bo 
logna until, very probably at the end of the thir 
teenth century, it had more students than any uni 
versity of the modern time. The number was not 
less than fifteen thousand, and may have been twenty 

To this great university success Taddeo and his 
medical school contributed not a little. The espe 
cially attractive feature of his teaching seems to 
have been its eminent practicalness. He himself 
had made an immense success of the practice of 
medicine, and accumulated a great fortune, so much 


so that Dante, in his " Paradise," when he wishes to 
find a figure that would represent exactly the op 
posite to what St. Dominic, the founder of the 
Dominicans, did for the love of wisdom and hu 
manity, he takes that of Taddeo, who had accom 
plished so much for personal reputation and 

This might easily lead to the impression that 
Taddeo s teaching was unscientific, or merely em 
piric, or that he himself was a narrow-minded maker 
of money, intent only on his immediate influence, 
and hampered by exclusive devotion to practical 
medicine. Nothing could be farther from the truth 
than any such impression. Taddeo was not only the 
head of a great medical school, a great teacher whom 
his students almost worshipped, a physician to whom 
patients flocked because of his marvellous success, 
a fine citizen of a great city, whom his fellow citizens 
honored, but he was a broad-minded scholar, a 
philosopher, and even an author in branches apart 
from medicine. 

In that older time it was the custom to combine 
the study of philosophy and medicine. For cen 
turies after that period in Italy it was the custom 
for men to take both degrees, the doctorate in 
philosophy and in medicine at the same time. In 
deed, most of those whose work has made them 
famous, down to and including Galvani, did so. 
Taddeo wrote commentaries on the works of Hip 
pocrates and Galen, but he also translated the 
ethics of Aristotle, and did much to make the learn 
ing of the Arabs easily available for his students. 
His was a broad, liberal scholarship. Dr. Lewis 


Flicker, in his article on " The Mondino Myth," 1 
does not hesitate to say that " to the spirit which, 
from his professorial chair, Taddeo infused into the 
teaching and study of medicine undoubtedly is due 
the high position which for many generations there 
after the school of Bologna continued to maintain as 
a centre of medical teaching." 

Of course, erudition had its revenge, and carried 
Taddeo too far. The difficult thing in human 
nature is to stay in the mean and avoid exaggera 
tion. His methods of illustrating medical truths 
from many literary and philosophical sources often 
caused the kernel of observation to be hidden be 
neath a blanket of speculation or, at least, to be 
concealed to a great extent. Even the Germans, 
who have insisted most on this unfortunate tendency 
of Taddeo, have been compelled to confess that there 
is much that is valuable in what he accomplished, 
and that even his modes of expression were not 
without a certain vivacity which attracted atten 
tion and doubtless added materially to his success 
as a teacher. Pagel, in Puschrnann s " Handbuch," 
says: " It cannot be denied [this is just after he has 
quoted a passage of Taddeo with regard to dreams] 
that Taddeo s expressions have a certain liveliness 
all their own that gives us some idea why he was 
looked upon as so good a teacher, a teacher who, as 
we know now, also gave instruction by the bedside 
of patients. Pagel adds, Taddeo s greatest merit 
and his highest significance in medical education 
consist in the fact that a great many (zahlreiche) 

1 The Medical Library and Historical Journal, Brooklyn, December, 


physicians followed directly in his footsteps and 
were counted as his pupils. They were all men, as 
we know them, who as writers and practitioners of 
medicine succeeded in going far beyond the level of 
mediocrity in what they accomplished." 

This was the teacher who most influenced young 
Mondino when he came to the University of Bo 
logna, for it seems not unlikely that as a medical 
student he was actually the pupil of Taddeo, then 
in a vigorous old age. If not, he was at least brought 
under the direct influence of the teaching tradition 
created during more than thirty years by that won 
derful old man. Knowing what we do of Taddeo it 
is not surprising that his pupil should have accom 
plished work that was to influence succeeding gen 
erations more than any other of that wonderful 
thirteenth century. Dr. Pilcher in the article on 
" The Mondino Myth," so often placed under contri 
bution in this sketch, says that " It needs no great 
stretch of the imagination to picture somewhat of 
the effect that contact with such a man as Taddeo di 
Alderotto L might have, in molding the character of 
his young neighbor and pupil, the chemist s son, who 
a few years later, by his devotion to the study of 
human anatomy, was to re-establish the practical 

Taddeo, who was born in 1215, according to our usually accepted 
traditions in the matter, would have been seventy-five years of age 
when Mondino as a youth of scarcely more than fifteen went to 
the University. It might seem that so old a man would have very 
little influence over the young man. Taddeo, however, had, as we 
have said, a very strenuous old age. Everything in life had come to 
him late. He was well past thirty before he began to study philoso 
phy and medicine, having been a seller of candles from necessity be 
cause of poverty in his younger years. His great success in practice 
came when he was past forty. He first began to teach when he was 


pursuit of study on the human cadaver as the com 
mon privilege of the skilled physician, and was to 
engrave his own name deeply on the records of 

Under this worthy compatriot and contemporary 
of the great Florentines, Mondino was inspired to be 
the teacher that did so much for Bologna. Until 
recent years it has usually been the custom to give 
too much significance to the work of the men whose 
names stand out most prominently in the early his 
tory of departments of the intellectual life. Mon 
dino s reputation has shared in this exaggerative 
tendency to some extent, hence the necessity for 
realizing what was accomplished before his time and 
the fact that he only stands as the culmination of a 
progressive period. Carlyle spoke of Dante as the 
man in whom " ten silent centuries found a voice." 
The centuries, however, were only silent because the 
moderns did not know how to listen to their mes 
sage. We know now that every country in Europe 
had a great contributor to literature in the century 
before Dante. The Cid, the Arthur Legends, the 
Xibelungen, the Troubadours, naturally led up to 
Dante. He was only the culmination of a great period 

forty-five, and he was nearly fifty-five before he began to write. 
According to tradition he married when he was nearly eighty 
whether for the first or second time is not said and while this might 
be considered, and would in some cases be, an indication of weak 
ness of character (it would probably depend on whether he married 
or was married), it seems in his case to have indicated a vigor of 
body and character which shows very clearly how great was the pos 
sibility of his influence as a teacher having been maintained even 
up to this late time of life, and thus influencing a pupil who is to 
represent the most potent influence at the beginning of the next 


of literature. "We know now that men had worked 
in art before Cimabue and Giotto, and had done im 
pressive work that made for the progress of art. 
These names, however, have come to represent in 
many minds the sort of solitary phenomena that 
Dante has seemed sometimes even to scholars. 

Because Mondino did such good work in medical 
teaching it is sometimes declared, even in rather seri 
ous histories, that he was the first to accomplish any 
thing in his department, and that before his time 
there is a blank. Some historians, for instance, have 
insisted that Mondino was the first to do human dis 
sections, and that he did at most but two or three. 
Only those who are unacquainted with the magnifi 
cent development of surgery that took place during 
the preceding century, the evidence for which is so 
abundantly given in modern historians of medicine 
and especially in G-urlt s great work on the history 
of surgery, from which we have quoted enough to 
give a good idea of the extent to which the move 
ment went, are likely to accept any such declaration. 
There could not have been all that successful sur 
gery without much dissection not only of animals 
but also of human bodies. The teaching of dissec 
tion was not regularly organized until Mondino s 
time, but it seems very clear that even he must have 
dissected many more bodies than the number usually 
attributed to him. Professor Lewis Stephen Pilcher 
of Brooklyn, who made a special study of Mondino 
traditions in Bologna itself, and collected some of the 
early editions of his books, feels so acutely the ab 
surdity of the ordinarily accepted tradition in this 
matter, that he has written a paper on the subject 


bearing the suggestive title, " The Mondino Myth." 
He says : l 

" We are accustomed to think of the practice of 
dissection as having been re-created by Mondino, and 
at once fully developed, springing into acceptance. 
The year 1315 is the generally accepted date for the 
first public anatomical demonstration upon a human 
body made by Mondino, and yet it is true that among 
the laws promulgated by Frederick II, more than 
seventy-five years before (A.D. 1231), was included 
a decree that a human body should be dissected at 
Salernum at least once in five years in the presence 
of the assembled physicians and surgeons of the 
kingdom, and that in the regulations established for 
admission to the practice of medicine and surgery 
in the kingdom it was decreed that no surgeon should 
be admitted to practise unless he should bring testi 
monials from the masters teaching in the medical 
faculty, that he was learned in the anatomy of 
human bodies, and had become perfect in that part 
of medicine without which neither incisions could 
safely be made nor fractures cured. 

" Salernum was notable in its legalization of the 
dissection of human bodies before the first public 
work of Mondino, for, according to a document of 
the Maggiore Consiglio of Venice of 1308, it appears 
that there was a college of medicine at Venice which 
was even then authorized to dissect a body every 
year. Common experience tells us that the embodi 
ment of such regulations into formal law would 
occur only after a considerable preceding period of 
discussion, and in this particular field of clandestine 
practice. It is too much to ask us to believe that 
in all this period, from the date of the promulgation 
of Frederick s decree of 1231 to the first public dem 
onstration by Mondino, at Bologna in 1315, the de- 

1 Medical Library and Historical Journal, 1906. 


cree had been a dead letter and no human body 
had been anatomized. It is true there is not, as far 
as I am aware, any record of an/ such work, and 
commentators and historians of a later date have, 
without exception, accepted the view that none was 
done, and thereby heightened the halo assigned to 
Mondino as the one who ushered in a new era. Such 
a view seems to me to be incredible. Be that as it 
may, it is undeniable that at the beginning of the 
14th century the idea of dissecting the human 
body was not a novel one; the importance of a 
knowledge of the intimate structure of the body had 
already been appreciated by divers ruling bodies, 
and specific regulations prescribing its practice had 
been enacted. It is more reasonable to believe that 
in the era immediately preceding that of Mondino 
human bodies were being opened and after a fash 
ion anatomized. All that we know of the work of 
Mondino suggests that it was not a new enterprise 
in which he was a pioneer, but rather that he brought 
to an old practice a new enthusiasm and better meth 
ods, which, caught on the rising wave of interest in 
medical teaching at Bologna, and preserved by his 
own energy as a writer in the first original system 
atic treatise written since the time of Galen, created 
for him in subsequent uncritical times the reputation 
of being the Restorer of the practice of anatomizing 
the human body, the first one to demonstrate and 
teach such knowledge since the time of the Ptolemaic 
anatomists, Erasistratus and Herophilus. 

" The changes have been rung by medical his 
torians upon a casual reference in Mondino s chapter 
on the uterus to the bodies of two women and one 
sow which he had dissected, as if these were the first 
and the only cadavers dissected by him. The con 
text involves no such construction. He is enforcing 
a statement that the size of the uterus may vary, 
and to illustrate it remarks that a woman whom I 


anatomized in the month of January last year, viz., 
1315 Anno Christi, had a larger uterus than one 
whom I anatomized in the month of March of the 
same year. And further, he says that the uterus 
of a sow which I dissected in 1316 (the year in which 
he was writing) was a hundred times greater than 
any I have seen in the human female, for she was 
pregnant and contained thirteen pigs. These hap 
pen to be the only reference to specific bodies that 
he makes in his treatise. But it is a far cry to wring 
out of these references the conclusion that these are 
the only dissections he made. It is quite true that 
if we incline to enshroud his work in a cloud of mys 
tery and to figure it as an unprecedented awe-inspir 
ing feature to break down the prejudices of the ages, 
it is easy to think of him as having timidly profaned 
the human body by his anatomizing zeal in but one 
or two instances. His own language, however, 
throughout his book is that of a man who was fa 
miliar with the differing conditions of the organs 
found in many different bodies; a man who was 
habitually dissecting." 

(Quotations from the work of Mundinus showing 
his familiarity with dissections. The leaf and line 
references are to the Dryander edition, Marburg, 

" I do not consider separately the anatomy of 
component parts, because their anatomy does not 
appear clearly in the fresh subject, but rather in 
those macerated in water." (Leaf 2, lines 8-13.) 

"... these differences are more noticeable in the 
cooked or perfectly dried body, and so you need not 
be concerned about them, and perhaps* I will make 
an anatomy upon such a one at another time and 
will write what I shall observe with my own senses, 
as I have proposed from the beginning." (Leaf 60* 
lines 14-17.) 

" What the members are to which these nerves 

V > 


come cannot well be seen in such a dissection as this, 
but it should be liquefied with rain water, and this is 
not contemplated in the present body." (Leaf 60, 
lines 31-33.) 

" After the veins you will note many muscles and 
many large and strong cords, the complete anatomy 
of which you will not endeavor to find in such a body 
but in a body dried in the sun for three years, as I 
have demonstrated at another time; I also declared 
completely their number, and wrote the anatomy of 
the muscles of the arms, hands, and feet in a lecture 
which I gave over the first, second, third, and fourth 
subjects." (Leaf 61, lines 1-7.) 

Very probably the best evidence that we have of 
the comparative frequency at least of dissection at 
this time is to be found in the records of a trial for 
body-snatching that occurred in Bologna. The de 
tails would remind one very much of what we know 
of the difficulties with regard to dissection in America 
a couple of generations ago, when no bodies were 
provided by law for dissection purposes. In the 
course of some studies for the history of the New 
York State Medical Society (New York, 1906) I 
found that nearly every one of the first half dozen 
presidents of the New York Academy of Medicine, 
which is not much more than sixty years old, had 
had body-snatching experiences when they were 
younger. Dr. Samuel Francis, the medico-historical 
writer, tells of a personal expedition across the ferry 
in the winter time, bringing a body from a Long 
Island graveyard. In order to avoid the constables 
on the Long Island side and the police on the New 
York side, because there had been a number of cases 
of body-snatching recently and the authorities were 


on the lookout, the corpse was placed sitting beside 
the physician who drove the wagon, with a cloak 
wrapped around it, as if it were a living person 
specially protected against the cold. Similar experi 
ences were not unusual. The lack of bodies for dis 
section is sometimes attributed to religious scruples, 
but they have very little to do with it, as at all times 
men have refused to allow the bodies of their friends 
to be treated as anatomical material. This is the 
natural feeling of abhorrence and not at all religious. 
It is only when there are many unclaimed bodies of 
strangers and the poor, as happens in large cities, 
that there can be an abundance of anatomical 

The details of this body-snatching case are 
strangely familiar to those who know the history of 
similar cases before the middle of the nineteenth cen 
tury. The case occurred in 1319 in Bologna, just 
four years after Mondino s public dissections. Four 
students were involved in the charge of body-snatch 
ing, all of them from outside the city of Bologna it 
self, three from Milan and one from Piacenza. In 
modern experience, too, as a rule, students from out 
side of the town where the medical college was situ 
ated, were always a little readier than natives to 
violate graveyards. These four students were ac 
cused of having gone at night to the Cemetery of 
St. Barnabas, outside the gate of San Felice, 
suburban graveyards were usually the scene of such 
exploits, and to have dug up the body of a certain 
criminal named Pasino, who had been hanged a few 
days before. They carried the body to the school in 
the Parish of San Salvatore, where Alberto Zancari 


was teaching. The resurrection had been accom 
plished without witnesses, but there were several 
witnesses who testified that they recognized the body 
of Pasino in the school and students occupied with 
its dissection. If evidence for the zeal of the medi 
cal students of that time for dissection were needed, 
surely we have it in the testimony at this trial. At 
a time when body-snatching has become a criminal 
offence usually there have been many repeated oc 
currences of it before the parties are brought to trial, 
so that it seems not unlikely that a good many dis 
sections of illegally secured bodies were being done 
at Bologna at this time. 

We know of a regulation of the University in 
force at this time, which required the teachers 
at the University to do an anatomy or dissection for 
students if they secured a body for that purpose. 
The students seem to have used all sorts of influ 
ence, political, monetary, diplomatic, and ecclesiasti 
cal, in order to secure the bodies of criminals. Some- 
tunes when they failed in their purpose they waited 
until after burial and then took the body without 
leave. When we recall the awfully deterrent condi 
tion in which bodies must have been that were thus 
provided for dissecting purposes, it is easy to under 
stand that the enthusiasm of the students for dis 
section must have been at a very high pitch. Cer 
tainly it was far higher than at the present day, 
when, in spite of the fact that our dissecting-rooms 
have very few of the old-time dangers and unpleas 
antnesses, dissection is only practised with assiduity 
if special care is exercised in requiring attendance 
and superintending the work of the department. 


In my book on " The Popes and Science " I have 
gathered the traditions relating to Mondino s as 
sistants in the chair of anatomy at Bologna. They 
furnish abundant evidence of the fact that dissec 
tions, far from being uncommon, must have been not 
at all infrequent at the north Italian universities at 
this time. Curiously enough, one of these assistants 
was a young woman who, as was not infrequently the 
custom at this time in the Italian universities, was 
matriculated as a student at Bologna. She took up 
first philosophy, and afterwards anatomy, under 
Mondino. While it is not generally realized, co-educa 
tion was quite common at the Italian universities of 
the thirteenth and fourteenth centuries, and at no 
time since the foundation of the universities has a 
century passed in Italy without distinguished women 
occupying professors chairs at some of the Italian 
universities. This young woman, Alessandra Gili- 
ani, of Persiceto, a country district not far from 
Bologna, took up the study of anatomy with ardor 
and, strange as it may appear, became especially 
enthusiastic about dissection. She became so skilful 
that she was made the prosector of anatomy, that is, 
one who prepares bodies for demonstration by the 

According to the " Cronaca Persicetana," quoted 
by Medici in his " History of the Anatomical School 
at Bologna ": 

" She became most valuable to Mondino because 
she would cleanse most skilfully the smallest vein, 
the arteries, all ramifications of the vessels, without 
lacerating or dividing them, and to prepare them for 


demonstration she would fill them with various 
colored liquids, which, after having been driven into 
the vessels, would harden without destroying the ves 
sels. Again, she would paint these same vessels to 
their minute branches so perfectly and color them so 
naturally that, added to the wonderful explanations 
and teachings of the master, they brought him great 
fame and credit." The whole passage shows a won 
derful anticipation of our most modern methods- 
injection, painting, hardening of making anatom 
ical preparations for class and demonstration pur 

Some of the details of the story have been doubted, 
but her memorial tablet, erected at the time of her 
death in the Church of San Pietro e Marcellino of 
the Hospital of Santa Maria de Mareto, gives all the 
important facts, and tells the story of the grief of her 
fiance, who was himself Mondino s other assistant. 1 
This was Otto Agenius, who had made for himself a 
name as an assistant to the chair of anatomy in 
Bologna, and of whom there were great hopes enter 
tained because he had already shown signs of genius 
as an investigator in anatomy. These hopes were 
destined to grievous disappointment, however, for 
Otto died suddenly, before he had reached his thirti 
eth year. The fact that both these assistants of Mon- 
dino died young and suddenly, would seem to point 

l Pilcher (he. cit.) tells of her tomb. I venture to change his 
translation of the inscription in certain unimportant particulars. 
He says: 

" We know the very place where she was buried in front of the 
Madonna delle Lettre in the Church of San Pietro e Marcellino of the 


to the fact that probably dissection wounds in those 
early days proved even more fatal than they occa 
sionally did a century or more ago, when the proper 
precautions against them were not so well under 
stood. The death of Mondino s two prosectors in 
early years would seem to hint at some such un 
fortunate occurrence. 

As regards the evidence of what the young man 
had accomplished before his untimely death, prob 
ably the following quotation, which Medici has taken 

Hospital of Santa Maria de Mareto, where her associate, Agenio, 
mourning and inconsolable, placed a tablet with this inscription: 

D . O . M . 

Vrceo . Content! 

Alexandras . Galinae . Pvellae . Persicetanae 

Penicillo . Egregiae . Ad . Anatomen . Exhibendam 

Et . Insignissimi . Medici , Mundini . Lucii 

Paucis . Comparandae . Discipulae . Cineres 

Carnis . Hie . Expectant . Resurrectionem 

Vixit . Ann . XIX . Obiit . Studio . Absunta 

Die XXVI Martii . A . S . MCCCXXVI 

Otto . Agenius . Lustrulanus . Ob . Earn . Demptam 

Sui . Potiori . Part* . Spoliatus . Sodali . Eximiae 

Ac . De . Se . Optime . Meritae . Inconsolabilis . M . P . 

This inscription may be translated as follows: 

In this urn enclosed 
The ashes of the body of 
Alexandra Giliani, a maiden of Periceto; 
Skilful with her brush in anatomical demonstrations 

And a disciple equalled by few, 
Of the most noted physician, Mundinus of Luzzi, 

Await the resurrection. 
She lived 19 years: she died consumed by her labors 

March 26, in the year of grace 1326. 

Otto Agenius Lustrulanus, by her taking away 

Deprived of his better part, his excellent companion, 

Deserving of the best, 
Has erected this tablet." 


from one of the old chroniclers, will give the best 
idea : 

: What advantage indeed might not Bologna have 
had from Otto Agenius Lustrulanus, whom Mon 
dino had used as an assiduous prosector, if he had 
not beeen taken away by a swift and lamentable death 
before he had completed the sixth lustrum of his 

How well the tradition created by Mondino con 
tinued at the university will be best understood from 
what we know of Guy de Chauliac s visit to the medi 
cal school here about the middle of the century. The 
great French surgeon tells us that he came to Bo 
logna to study anatomy under the direction of Mon 
dino s successor, Bertruccius. When he wrote his 
preface to his great surgery he recalled this teaching 
of anatomy at Bologna and said, "It is necessary 
and useful to every physician to know, first of all, 
anatomy. For this purpose the study of books is 
indeed useful, but it is not sufficient to explain those 
things which can only be appreciated by the senses 
and which need to be seen in the dead body itself." 
He advises his students to consult Mundinus treatise 
but to demonstrate its details for themselves on the 
dead body. He relates that he himself had often, 
multitoties, done this, especially under the direction 
of Bertruccius at Bologna. Curiously enough, as 
pointed out by Professor Pilcher, Mondino had used 
this same word multitotiens (the variant spelling 
makes no difference in the meaning) in speaking 
about his own work. In describing the hypogastric 
lesion he mentions that he had demonstrated cer 
tain veins in it many times, multitotiens. 


Mondino was just past fifty when he finished his 
little book and permitted copies of it to be made. 
Though the book occurs so early in the history of 
modern book-making the author offers his excuses to 
the public for writing it, and quotes the authority 
of Galen, to whom he turns in other difficult situ 
ations, for justification. As prefaces go, Mondino s 
is so like that of many an author of more recent 
date that his words have a bibliographic, as well as 
a personal, interest. He said: 

A work upon any science or art as saith Galen 
is issued for three reasons: first, that one may 
satisfy his friends. Second, that he may exercise 
his best mental powers. Third, that he may be saved 
from the oblivion incident to old age. Therefore, 
moved by these three causes, I have proposed to my 
pupils to compose a certain work on medicine. 

" And because a knowledge of the parts to be 
subjected to medicine (which is the human body, 
and the names of its various divisions) is a part 
of medical science, as saith Averrhoes in his first 
chapter, in the section on the definition of medicine, 
for this reason among others, I have set out to lay 
before you the knowledge of the parts of the human 
body which is derived from anatomy, not attempting 
to use a lofty style, but the rather that which is 
suitable to a manual of procedure." 

Some of the early editions of Mondinus book are 
said, according to old writers, to have contained illus 
trations. Xone of these copies have come down to 
us, but the assertion is made so definitely that it 
seems likely to have been the case. The editions 
that we have contain wood engravings of the method 
of making a dissection as frontispiece, so that it 


would not be difficult to think of further such illus 
trations having been employed in the book itself. As 
we note in the chapter on " Great Surgeons of the 
Medieval Universities," Mondeville, according to 
Guy de Chauliac, had pictures of anatomical prepara 
tions which he used for teaching purposes. It is 
easy to understand that the value of such aids would 
be recognized at a time when the difficulty of preserv 
ing bodies made it necessary to do dissections hur 
riedly so as to get the rapidly decomposing material 
out of the way. 

Beyond his book and certain circumstances con 
nected with it we know very little about Mondino. 
What we know, however, enables us to conclude that, 
like many another great teacher, he must have had 
the special faculty of inspiring his students with an 
ardent enthusiasm for the work that they were tak 
ing under him. Hence the body-snatching and other 
stories. Mondino continued to be held in high esti 
mation by the Bolognese for centuries after his 
death. Dr. Pilcher calls attention to the fact that 
his sepulchral tablet, which is in the portico of the 
Church of San Vitari in Bologna, and a replica of 
which he was allowed to have made in order to bring 
it to America, is the only one of the sepulchral tablets 
in the great churches of Florence, San Domenico, 
San Martino, the Cathedral and the Cloister of San 
Giacomo degli Ermitani, which has not been removed 
from its original location and placed in the halls of 
the Civic Museum. Their removal he considers u a 
kind of desecration which does violence to one s sense 
of sanctity and propriety. " Fortunately, thus far, 
the Mondino Tablet has escaped the spoiler." Very 


probably Dr. Flicker s replica of the tablet which he 
was required to deposit in the Civic Museum at the 
time when the copy was made to be brought to 
America may save the tablet to be seen in its original 
position for many generations. 

Mondino s career is of special interest because it 
foreshadows the life and accomplishment of many 
another maker of medicine of the after time. He 
did a great new thing in medicine in organizing 
regular public dissections, and then in making a 
manual that would facilitate the work. He waited 
patiently for years before completing his book in 
order that it might be the fruit of long experience, 
and so be more helpful to others. He was so modest 
as to require urging to secure the publication. He 
bad the reward of bis patience in the popularity of 
his little work for centuries after his time. The 
glimpse that we get of his relations to his young 
assistants, Agenius and Alessandra, seems to show 
us a teacher of distinct personal magnetism. Un 
doubtedly the reputation of his book did much for 
not only the medical school of the University of 
Bologna, but also for the medical schools of other 
north Italian universities, and helped to bring to 
them the crowds of students that flocked there during 
the fourteenth and fifteenth centuries. 

Taddeo and Mondino turned the attention of the 
medical students of their generations Bolognawards. 
Before that time they had mainly gone to Salerno. 
After their time most of the ardent students of medi 
cine felt that they must study for a time at least at 
Bologna. Other important medical schools of Italian 
universities at Padua, at Vicenza, at Piacenza, arose 


and prospered. During the time when the political 
troubles of Italy reached a climax about the middle 
of the fourteenth century, while the Popes were at 
Avignon, there was a remission in the attendance at 
all the Italian universities, but with the Popes re 
turn to Rome and the coming of even comparative 
peace to Italy, Bologna once more became the term 
of medical pilgrimages for students from all over 
the world. In the meantime Mondino s book went 
forth to be the most used text-book of its kind until 
Vesalius great work came to replace it. To have 
ruled in the world of anatomy for two centuries as 
the best known of teachers is of itself a distinction 
that shows us at once the teaching power and the 
scientific ability of this professor of anatomy of 
Bologna in the early fourteenth century. 


Strange as it may appear to those who have not 
watched the development of our knowledge of the 
Middle Ages in recent years the most interesting 
feature in the medical departments and, indeed, of 
the post-graduate work generally of the medieval 
universities, is that in surgery. There is a very gen 
eral impression that this department of medicine did 
not develop until quite recent years, and that par 
ticularly it failed to develop to any extent in the 
Middle Ages. A good many of the historians of this 
period, indeed, though never the special historians 
of medicine, have even gone far afield in order to 
find some reason why surgery did not develop at this 
time. They have insisted that the Church by its 
prohibition of the shedding of blood, first to monks 
and friars, and then to the secular clergy, prevented 
the normal development of surgery. Besides they 
add that Church opposition to anatomy completely 
precluded all possibility of any genuine natural evo 
lution of surgery as a science. 

There is probably no more amusing feature of 
quite a number of supposedly respectable and pre 
sumably authoritative historical works written in 
English than this assumption with regard to the ab 
sence of surgery during the later Middle Ages. Only 



the most complete ignorance of the actual history of 
medicine and surgery can account for it. The writers 
who make such assertions must never have opened an 
authoritative medical history. Nothing illustrates so 
well the expression of the editors of the Cambridge 
Modern History " referred to more than once in 
these pages that " in view of changes and of gains 
such as these [the printing of original documents] 
it has become impossible for historical writers of the 
present day to trust without reserve even to the most 
respected secondary authority. The honest student 
finds himself continually deserted, retarded, misled 
by the classics of historical literature." Fortunately 
for us this sweeping condemnation does not hold to 
any great extent for the medical historical classics. 
All of the classic historians of medicine tell us much 
of the surgery of the thirteenth and fourteenth cen 
turies, and in recent years the republication of old 
tests and the further study of manuscript documents 
of various kinds have made it very clear that there 
is almost no period in the history of the world when 
surgery was so thoroughly and successfully culti 
vated as during the rise and development of the uni 
versities and their medical schools in the thirteenth 
and fourteenth centuries. 

It is interesting to trace the succession of great 
contributors to surgery during these two centuries. 
We know their teaching not from tradition, but from 
their text-books so faithfully preserved for us by 
their devoted students, who must have begrudged 
no time and spared no labor in copying, for many of 
the books are large, yet exist in many manuscript 


Modern surgery may be said to owe its origin to a 
school of surgeons, the leaders of whom were edu 
cated at Salerno in the early part of the thirteenth 
century, and who, teaching at various north Italian 
universities, wrote out their surgical principles and 
experiences in a series of important contributions to 
that department of medical science. The fact that 
the origin of the school was at Salerno, where, as is 
well known, Arabian influence counted for much and 
for which Constantine s translations of Arabian 
works proved such a stimulus a century before, 
makes most students conclude that this later medie 
val surgical development is simply a continuation of 
the Arabian surgery that, as we have seen, developed 
very interestingly during the earlier Middle Ages. 
Any such idea, however, is not founded on the reali 
ties of the situation, but on an assumption with re 
gard to the extent of Arabian influence. Gurlt in his 
" History of Surgery " (Vol. I, page 701) completely 
contradicts this idea, and says with regard to the 
first of the great Italian writers on surgery, Rogero, 
that " though Arabian works on surgery had been 
brought over to Italy by Constantine Africanus a 
hundred years before Roger s time, these exercised 
no influence over Italian surgery in the next century, 
and there is scarcely a trace of the surgical knowl 
edge of the Arabs to be found in Roger s works." 

It is in the history of medicine particularly that it 
is possible to trace the true influence of the Arabs on 
European thought in the later Middle Ages. We 
have already seen in the chapter on Salerno that 
Arabian influence did harm to Salernitan medical 
teaching. The school of Salerno itself had developed 


simple, dietetic, hygienic, and general remedial meas 
ures that included the use of only a comparatively 
small amount of drugs. Its teachers emphasized 
nature s curative powers. With Arabian influence 
came polypharmacy, distrust of nature, and attempts 
to cure disease rather than help nature. In surgery, 
which developed very wonderfully in the thirteenth 
and fourteenth centuries, Salerno must be credited 
with the incentive that led up to the marvellous de 
velopment that came. With this, however, Arabian 
influence has nothing to do. Gurlt, besides calling 
attention to the fact that the author of the first great 
text-book on the subject not only did not draw his in 
spiration from Arab sources, insisted that " instead 
of any Arabisms being found in his [Roger s] writ 
ings many Graecisms occur." The Salernitan school 
of surgery drank at the fountain-head of Greek sur 
gery. Apart from Greek sources Roger s book rests 
entirely upon his own experiences, those of his teach 
ers and his colleagues, and the tradition in surgery 
that had developed at Salerno. This tradition was 
entirely from the Greek. Roger himself says in one 
place, " We have resolved to write out deliberately 
our methods of operation such as they have been 
derived from our own experience and that of our 
colleagues and illustrious men." 


Ruggero, or Rogero, who is also known as Rogerio 
and Rogerus with the adjective Parmensis, or Saler- 
nitanus, of Parma or of Salerno, and often in Ger 
man and English history simply as Roger, lived at 


the end of the twelfth or the beginning of the thir 
teenth century and probably wrote his text-book 
about 1180. This text-book was, according to tradi 
tion, originally drafted for his lessons in surgery at 
Salerno. It attracted much attention and after being 
commented on by his pupil Rolando, the work of 
both of them being subsequently annotated by the 
Four Masters, this combined work became the basis 
of modern surgery. Roger was probably born either 
in Palermo or Parma. There are traditions of his 
having taught for a while at Paris and at the Uni 
versity of Montpellier, though these are not substan 
tiated. His book was printed at Venice in 1546, and 
has been lately reprinted by De Renzi in his " Col- 
lectio Salernitana." 

Roland was a pupil of Roger s, and the two names 
that often occur in medieval romance became asso 
ciated in a great historic reality as a consequence of 
Roland s commentary on his master s work, which 
was a favorite text-book in surgery for a good while 
in the thirteenth century at Salerno. Some space will 
be given to the consideration of their surgical teach 
ing after a few words with regard to some disciples 
who made a second commentary, adding to the value 
of the original work. 

This is the well-known commentarv of the Four 


Masters, a text-book of surgery written somewhat in 
the way that we now make text-books in various de 
partments of medicine, that is, by asking men who 
have made specialties of certain subjects to write on 
that subject and then bind them all together in a 
single volume. It represents but another striking 
reminder that most of our methods are old, not new 


as we are likely to imagine them. The Four Masters 
took the works of Roger and Eolando, acknowledged 
their indebtedness much more completely than do our 
modern writers on all occasions, I fear, and added 
their commentaries. 

G-urlt says (" Geschichte der Chirurgie," Vol. I, p. 
703) that " in spite of the fact that there is some 
doubt about the names of the authors, this volume 
constitutes one of the most important sources for the 
history of surgery of the later Middle Ages and 
makes it very clear that these writers drew their 
opinions from a rich experience." It is rather easy 
to illustrate from the quotations given in Gurlt or 
from the accounts of their teaching in Daremberg or 
De Eenzi some features of this experience that can 
scarcely fail to be surprising to modern surgeons. 
For instance, what is to be found in this old text 
book of surgery with regard to fractures of the skull 
is likely to be very interesting to surgeons at all 
times. One might be tempted to say that fewer men 
would die every year in prison cells who ought to 
be in hospitals, if the old-time teaching was taken to 
heart. For there are rather emphatic directions not 
to conclude because the scalp is unwoundedthat there 
can be no fracture of the skull. Where nothing can 
be felt care must be exercised in getting the history 
of the case. For instance, if a man is hit by a metal 
instrument shaped like the clapper of a bell or by a 
heavy key, or by a rounded instrument made of lead 
this would remind one very much of the lead pipe 
of the modern time, so fruitful of mistakes of diag 
nosis in head injuries special care must be taken to 
look for symptoms in spite of the lack of an external 


penetrating wound. Where there is good reason to 
suspect a fracture because of the severity of the in 
jury, the scalp should be incised and a fracture of the 
cranium looked for carefully. That is carrying the 
exploratory incision pretty far. If a fracture is 
found the surgeon should trephine so as to relieve the 
brain of any pressure of blood that might be affect 
ing it. 

There are many warnings, however, of the danger 
of opening the skull and of the necessity for defi 
nitely deciding beforehand that there is good reason 
for so doing. How carefully their observations had 
been made and how well they had taken advantage 
of their opportunities, which were, of course, very 
frequent in those warlike times when firearms were 
unknown, hand-to-hand conflict common, and blunt 
weapons were often used, can be appreciated very 
well from some of the directions. For instance, they 
knew of the possibility of fracture by contrecoup. 
They say that quite frequently though the percus 
sion conies in the anterior part of the cranium, the 
cranium is fractured on the opposite part." 1 They 
even seem to have known of accidents such as we now 
discuss in connection with the laceration of the mid 
dle meningeal artery. They warn surgeons of the 
possibilities of these cases. They tell the story of 
" a youth who had a very small wound made by a 
thrown stone and there seemed no serious results or 
bad signs. He died the next day, however. His 
cranium was opened and a large amount of black 

This is so striking that I quote their actual words from Gurlt, p. 
704 : " Multoties jit percussio in anteriori parte cranei et craneum in 
parte frangitur contraria." 


blood was found coagulated about his dura 

There are many interesting things said with re 
gard to depressed fractures and the necessity for 
elevating the bone. If the depressed portion is 
wedged then an opening should be made with the 
trephine and an elevating instrument called a spatu- 
men used to relieve the pressure. Great care should 
be taken, however, in carrying out this procedure 
lest the bone of the cranium itself, in being lifted, 
should injure the soft structures within. The dura 
mater should be carefully protected from injury as 
well as the pia. Care should especially be exercised 
at the brow and the rear of the head and at the com 
missures (proram et pupim et commissuras), since 
at these points the dura mater is likely to be ad 
herent. Perhaps the most striking expression, the 
word infect being italicized by Gurlt, is: "In ele 
vating the cranium be solicitous lest you should infect 
or injure the dura mater." 

For wounds of the scalp sutures of silk are recom 
mended because this resists putrefaction and holds 
the wound edges together. Interrupted sutures 
about a finger-breadth apart are recommended. 
" The lower part of the wound should be left open 
so that the cure may proceed properly." Eed pow 
der was strewed over the wound and the leaf of a 
plant set above it. In the lower angle of the wound 
a pledget of lint for drainage purposes was inlaid. 
Hemorrhage was prevented by pressure, by the bind 
ing on of burnt wool firmly, and by the ligature of 
veins and by the cautery. 

There are rather interesting discussions of the 


prognosis of wounds of the head, especially such as 
may be determined from general symptoms in this 
commentary of the Four Masters on Roger s and 
Rolando s treatises. If an acute febrile condition 
develops, the wound is mortal. If the patient loses 
the use of the hands and feet or if he loses his power 
of direction, or his sensation, the wound is mortal. 
If a universal paralysis comes on, the wound is mor 
tal. For the treatment of all these wounds careful 
precautions are suggested. Cold was supposed to be 
particularly noxious to them. Operations on the 
head were not to be done in cold weather and, above 
all, not in cold places. The air where such operations 
were done must be warmed artificially. Hot plates 
should surround the patient s head while the opera 
tion was being performed. If this were not possible 
they were to be done by candlelight, the candle being 
held as close as possible in a warm room. These 
precautions are interesting as foreshadowing many 
ideas of much more modern time and especially indi 
cating how old is the idea that cold may be taken in 
wounds. In popular medicine this still has its place. 
Whenever a wound does badly in the winter time pa 
tients are sure that they have taken cold. Such popu 
lar medical ideas are always derived from sup 
posedly scientific medicine, and until we learned 
about microbes physicians used the same expressions. 
We have not got entirely away from them yet. 

These old surgeons must have had many experi 
ences with fractures at the base of the skull. Hemor 
rhages from the mouth and nose, for instance, and 
from the ears were considered bad signs. They were 
inclined to suggest that openings into the skull should 


be discovered by efforts to demonstrate a connection 
between the mouth, and nares and the brain cavity. 
For instance, in their commentary the Four Masters 
said : Let the patient hold his mouth and nostrils 
tight shut and blow strongly." If there was any 
lessening of the pressure or any appearance of air 
in the wound in the scalp, then a connection between 
the mouth and nose was diagnosticated. This is in 
genious but eminently dangerous because of the in 
fectious material contained in the nasal and oral 
cavities, so likely to be forced by such pressure into 
the skull. They were particularly anxious to detect 
linear fractures. One of their methods of negative 
diagnosis for fractures of the skull was that if the 
patient were able to bring his teeth together strongly, 
or to crack a nut without pain, then there was no 
fracture present. One of the commentators, how 
ever, adds to this " sed hoc aliquando fallit but this 
sign sometimes fails." Split or crack fractures were 
also diagnosticated by the method suggested by Hip 
pocrates of pouring some colored fluid over the skull 
after the bone was exposed, when the linear fracture 
would show by coloration. The Four Masters sug 
gest a sort of red ink for this purpose. 

While they have so much to say about fractures 
of the skull and insist, over and over again, that 
though all depressed fractures need treatment and 
many fissure fractures require trepanation, still 
great care must be exercised in the selection of cases. 
They say, for instance, that surgeons who in every 
serious wound of the head have recourse to the 
trephine must be looked upon as " fools and idiots " 
(idioti et stolidi). In the light of what we now know 


about the necessity for absolute cleanliness, asep 
sis as we have come to call it, it is rather startling 
to note the directions that are given to a surgeon to 
be observed on the day when he is to do a trepana 
tion. For obvious reasons I prefer to quote it in the 
Latin: " Et uota quod die ilia cavendum est medico a 
coitu et mails cibis aera corrumpentibus, ut sunt 
allia, cepe, et liujusmodi, et colloquio mulieris men- 
struoscp, et manus ejus debent esse mun dee, etc." 
My quotation is from Gurlt, Vol. I, p. 707. The direc 
tions are most interesting. The surgeon s hands must 
be clean, he must avoid the taking of food that may 
corrupt the air, such as onions, leeks, and the like; 
must avoid menstruating and other women, and in 
general must keep himself in a state of absolute 

To read a passage like this separated from its 
context and without knowing anything about the 
wonderful powers of observation of the men from 
whom it comes, it would be very easy to think that 
it is merely a set of general directions which they 
had made on some general principle, perhaps quite 
foolish in itself. We know, however, that these men 
had by observation detected nearly every feature of 
importance in fractures of the skull, their indications 
and contra-indications for operation and their prog 
nosis. They had anticipated nearly everything of 
importance that has come to be insisted on even in 
our own time in the handling of these difficult cases. 
It is not unlikely, therefore, that they had also ar 
rived at the recognition by observations on many 
patients that the satisfactory after-course of these 
cases which were operated on by the surgeon after 


due regard to such meticulous cleanliness as is sug 
gested in the paragraph I have quoted, made it very 
clear that these aseptic precautions, as we would 
call them, were extremely important for the outcome 
of the case and, therefore, were well worth the sur 
geon s attention, though they must have required 
very careful precautions and considerable self-denial. 
Indeed this whole subject, the virtual anticipation of 
our nineteenth-century principles of aseptic surgery 
in the thirteenth century, is not a dream nor a far 
fetched explanation when one knows enough about 
the directions that were laid down in the surgical 
text-books of that time. 


After Eoger and Rolando and the Four Masters, 
who owe the inspiration for their work to Salerno 
and the south of Italy, comes a group of north 
Italian surgeons: Bruno da Longoburgo, usually 
called simply Bruno ; Theodoric and his father, Hugo 
of Lucca, and William of Salicet. Immediately fol 
lowing them come two names that belong, one almost 
feels, to a more modern period : Mondino, the author 
of the first text-book on dissection, and Lanfranc (the 
disciple of William of Salicet), who taught at Paris 
and " gave that primacy to French surgery which it 
maintained all the centuries down to the nineteenth " 
(Pagel). It might very well be thought that /this 
group of Italian surgeons had very little in their 
writings that would be of any more than antiquarian 
interest for the modern time. It needs but a little 
knowledge of their writings as they have come down 


to us to show how utterly false any such opinion is. 
To Hugo da Lucca and his son Theodoric we owe 
the introduction and the gradual bringing into prac 
tical use of various methods of anaesthesia. They 
used opium and mandragora for this purpose and 
later employed an inhalant mixture, the composition 
of which is not absolutely known. They seem, how 
ever, to have been very successful in producing in 
sensibility to pain for even rather serious and com 
plicated and somewhat lengthy operations. Indeed 
it is to this that must be attributed most of their 
surprising success as surgeons at this early date. 

"We are so accustomed to think that anaesthesia was 
discovered about the middle of the nineteenth cen 
tury in America that we forget that literature is 
full of references in Tom Middleton s (seventeenth 
century) phrase to " the mercies of old surgeons who 
put their patients to sleep before they cut them." 
Anaesthetics were experimented with almost as zeal 
ously, during the latter half of the thirteenth century 
at least, as during the latter half of the nineteenth 
century. They were probably not as successful as we 
are,but they did succeed in producing insensibility to 
pain, otherwise they could never have operated to the 
extent they did. Moreover the traditions show that 
the Da Luccas particularly had invented a method 
that left very little to be desired in this matter of 
anaesthesia. A reference to the sketch of Guy de 
Chauliac in this volume will show how practical the 
method was in his time. 

Nearly the same story as with regard to anaesthet 
ics has to be repeated for what are deemed so surely 
modern developments, asepsis and antisepsis. I 


have already suggested that Roger seems to have 
known how extremely important it was to approach 
operations upon the skull with the most absolute 
cleanliness. There are many hints of the same kind 
in other writers which show that this was no mere 
accidental remark, but was a definite conclusion de 
rived from experience and careful observation of 
results. We find much more with regard to this same 
subject in the writings of the group of northern Ital 
ian surgeons and especially in the group of those 
associated with William of Salicet. Professor Clif 
ford Allbutt, Regius Professor of Medicine at the 
University of Cambridge, England, in his address 
before the St. Louis World s Fair Congress of Arts 
and Science in 1904, did not hesitate to declare that 
William discussed the causes for union by first in 
tention and the modes by which it might be obtained. 
He, too, insisted on cleanliness as the most impor 
tant factor in having good surgical results, and all 
of this group of men, in operating upon septic cases, 
used stronger wine as a dressing. This exerted, as 
will be readily understood, a very definite antiseptic 

Evidently some details of the teaching of this 
group of great surgeons in northern Italy in the 
second half of the thirteenth century will make 
clearer to us how much the rising universities of the 
time were accomplishing in medicine and surgery as 
well as in their other departments. The dates of 
the origin of some of these universities should per 
haps be recalled so as to remind readers how closely 
related they are to this great group of surgical teach 
ers. Salerno was founded very early, probably in 


the tenth century; Bologna, Reggio, and Modena 
came into existence toward the end of the twelfth 
century; Vicenza, Padua, Naples, Vercelli, and Pi- 
acenza, as well as Arezzo, during the first half of the 
thirteenth century; Rome, Perugia, Trevizo, Pisa, 
Florence, Sienna, Lucca, Pavia, and Ferrara during 
the next century. The thirteenth century was the 
special flourishing period of the universities, and 
the medical departments, far from being behind, 
were leaders in accomplishment. (See my " The 
Thirteenth Greatest of Centuries," N. Y., 1908.) 


The first of this important group of north Italian 
surgeons who taught at these universities was Bruno 
of Longoburgo. While he was born in Calabria, and 
probably studied in Salerno, his work was done at 
Vicenza, Padua, and Verona. His text-book, the 
" Chirurgia Magna," dedicated to his friend An 
drew of Piacenza, was completed at Padua in Jan 
uary, 1252. Gurlt notes that he is the first of the 
Italian surgeons who quotes, besides the Greeks, the 
Arabian writers on surgery. Eclecticism had defi 
nitely come into vogue to replace exclusive devotion 
to the Greek authors, and men were taking what 
was good wherever they found it. Gurlt tells us that 
Bruno owed much of what he wrote to his own ex 
perience and observation. He begins his work by a 
definition of surgery, chirurgia, tracing it to the 
Greek and emphasizing that it means handwork. He 
then declares that it is the last instrument of medi 
cine to be used only when the other two instruments, 


diet and potions, have failed. He insists that sur 
geons mnst learn by seeing surgical operations and 
watching them long and diligently. They must be 
neither rash nor over bold and should be extremely 
cautious about operating. "While he says that he 
does not object to a surgeon taking a glass of wine, 
the followers of this specialty must not drink to 
such an extent as to disturb their command over 
themselves, and they must not be habitual drinkers. 
While all that is necessary for their art cannot be 
learned out of books, they must not despise books 
however, for many things can be learned readily 
from books, even about the most difficult parts of 
surgery. Three things the surgeon has to do : to 
bring together separated parts, to separate those 
that have become abnormally united, and to extirpate 
what is superfluous." 

In his second chapter on healing he talks about 
healing by first and second intention. Wounds must 
be more carefully looked to in summer than in win 
ter, because putrefactio est major in aestate quam 
in hyeme, putrefaction is greater in summer than in 
winter. For proper union care must be exercised to 
bring the wound edges accurately together and not 
allow hair, or oil, or dressings to come between 
them. In large wounds he considers stitching indis 
pensable, and recommends for this a fine, square 
needle. The preferable suture material in his experi 
ence was silk or linen. 

The end of the wound was to remain open in order 
that lint might be placed therein in order to draw 
off any objectionable material. He is particularly 
insistent on the necessity for drainage. In deep 


wounds special provision must be made, and in 
wounds of extremities the limb must be so placed 
as to encourage drainage. If drainage does not take 
place, then either the wound must be thoroughly 
opened, or if necessary a counter opening must be 
made to provide drainage. All his treatment of 
wounds is dry, however. Water, he considered, al 
ways did harm. We can readily understand that the 
water generally available and especially as surgeons 
saw it in camps and on the battlefield, was likely to 
do much more harm than good. In penetrating 
wounds of the belly cavity, if there was difficulty 
in bringing about the reposition of the intestines, 
they were first to be pressed back with a sponge 
soaked in warm wine. Other manipulations are sug 
gested, and if necessary the wound must be enlarged. 
If the omentum finds its way out of the wound, all 
of it that is black or green must be cut off. In 
cases where the intestines are wounded they are to 
be sewed with a small needle and a silk thread and 
care is to be exercised in bringing about complete 
closure of the wound. This much will give a good 
idea of Bruno s thoroughness. Altogether, Gurlt, 
in his " History of Surgery," gives about fifteen 
large octavo pages of rather small type to a brief 
compendium of Bruno s teachings. 

One or two other remarks of Bruno are rather 
interesting in the light of modern developments in 
medicine. For instance, he suggests the possibility 
of being able to feel a stone in the bladder by means 
of bimanual palpation. He teaches that mothers 
may often be able to cure hernias, both umbilical and 
inguinal, in children by promptly taking up the treat- 


ment of them as soon as noticed, bringing the edges 
of the hernial opening together by bandages and 
then preventing the reopening of the hernia by pro 
hibiting wrestling and loud crying and violent mo 
tion. He has seen overgrowth of the niamma in 
men, and declares that it is due to nothing else but 
fat, as a rule. He suggests if it should hang down 
and be in the way on account of its size it should 
be extirpated. He seems to have known considera 
ble about the lipomas and advises that they need 
only be removed in case they become bothersornely 
large. The removal is easy, and any bleeding that 
takes place may be stopped by means of the cautery. 
He divides rectal fistulae into penetrating and non- 
penetrating, and suggests salves for the non-pene 
trating and the actual cautery for those that pene 
trate. He warns against the possibility of producing 
incontinence by the incision of deep fistulse, for this 
would leave the patient in a worse state than before. 


Bruno brought up with him the methods and prin 
ciples of surgery from the south of Italy, but there 
seems to have been already in the north at least one 
distinguished surgeon who had made his mark. This 
was Ugo da Lucca or Ugo Luccanus, sometimes 
known in the modern times in German histories of 
medicine as Hugo da Lucca and in English, Hugh of 
Lucca. He flourished early in the thirteenth cen 
tury. In 1214 he was called to Bologna to become 
the city physician, and joined the Bolognese volun 
teers in the crusade in 1218, being present at the 


siege of Damietta. He returned to Bologna in 1221 
and was given the post of legal physician to the city. 
The civic statutes of Bologna are, according to Gurlt, 
the oldest monument of legal medicine in the Middle 
Ages. Ugo died not long after the middle of the 
century, and is said to have been nearly one hundred 
years old. Of his five sons, three became physicians. 
The most celebrated of these was Theodoric, who 
wrote a text-book of surgery in which are set down 
the traditions of surgery that had been practised in 
his father s life. Theodoric is especially enthusiastic 
in praise of his father, because he succeeded in bring 
ing about such perfect healing of wounds with only 
wine and water and the ligature and without the 
employment of an} ointments. 

Ugo seems to have occupied himself much with 
chemistry. To him we owe a series of discoveries 
with regard to anodyne and anaesthetizing drugs. 
He is said to have been the first who taught the 
sublimation of arsenic. Unfortunately he left no 
writings after him, and all that we know of him we 
owe to the filial devotion of his son Theodoric. 


This son, after having completed his medical 
studies at the age of about twenty-three, en 
tered the Dominican Order, then only recently 
established, but continued his practice of medi 
cine undisturbed. His ecclesiastical preferment 
was rapid. He attracted the attention of the 
Bishop of Valencia, and became his chaplain 
in Rome. At the age of about fifty he was made 


a bishop in South Italy and later transferred 
to the Bishopric of Cervia, not far from Ravenna. 
Most of his life seems to have been passed in Bo 
logna however, and he continued to practise medi 
cine, devoting his fees, however, entirely to charity. 
His text-book of surgery was written about 1266 
and is signed with his full name and title as Bishop 
of Cervia. Even at this time however, he still re 
tained the custom of designating himself as a mem 
ber of the Dominican Order. 

The most interesting thing in the first book of 
his surgery is undoubtedly his declaration that all 
wounds should be treated only with wine and ban 
daging. Wine he insists on as the best possible 
dressing for wounds. It was the most readily availa 
ble antiseptic that they had at that time, and un 
doubtedly both his father s recommendation of it and 
his own favorable experience with it were due to 
this quality. It must have acted as an excellent in- 
hibitive agent of many of the simple forms of pus 
formation. At the conclusion of this first book he 
emphasizes that it is extremely important for the 
healing of wounds that the patient should have good 
blood, and this can only be obtained from suitable 
nutrition. It is essential therefore for the physician 
to be familiar with the foods which produce good 
blood in order that his wounded patients may be fed 
appropriately. He suggests, then, a number of arti 
cles of diet which are particularly useful in produc 
ing such a favorable state of the tissues as will bring 
about the rebirth of flesh and the adhesion of wound 
surfaces. Shortly before he emphasizes the neces 
sity for not injuring nerves, though if nerves have 


been cut they should be brought together as carefully 
as possible, the wound edges being then approxi 

Probably the most interesting feature for our gen 
eration of the great text-books of the surgeons of 
the medieval universities is the occurrence in them 
of definite directions for securing union in surgical 
wounds, at least by first intention and their insist- 
ence on keeping wounds clear. The expression 
union by first intention comes to us from the olden 
time. They even boasted that the scars left after 
their incisions were often so small as to be scarcely 
noticeable. Such expressions of course could only 
have come from men who had succeeded in solving 
some of the problems of antisepsis that were solved 
once more in the generation preceding our own. 
With regard to their treatment of wounds, Professor 
Clifford Allbutt says : * 

" They washed the wound with wine, scrupulously 
removing every foreign particle; then they brought 
the edges together, not allowing wine nor anything 
else to remain within dry adhesive surfaces were 
their desire. Nature, they said, produces the means 
of union in a viscous exudation, or natural balm, as 
it was afterwards called by Paracelsus, Pare, and 
YVurtz. In older wounds they did their best to ob 
tain union by cleansing, desiccation, and refreshing 
of the edges. Upon the outer surface they laid only 
lint steeped in wine. Powders they regarded as too 
desiccating, for powder shuts in decomposing mat 
ters ; wine after washing, purifying, and drying th-? 
raw surfaces evaporates." 

^ Historical Relations of Medicine and Surgery Down to the Six 
teenth Century," London, 1904. 


Theodoric comes nearest to us of all these old sur 
geons. The surgeon who in 1266 wrote: " For it 
is not necessary, as Roger and Eoland have written, 
as many of their disciples teach, and as all modern 
surgeons profess, that pus should be generated in 
wounds. No error can be greater than this. Such 
a practice is indeed to hinder nature, to prolong the 
disease, and to prevent the conglutination and con 
solidation of the wound " was more than half a mil 
lennium ahead of his time. The italics in the word 
modern are mine, but might well have been used by 
some early advocate of antisepsis or even by Lord 
Lister himself. Just six centuries almost to the year 
would separate the two declarations, yet they 
would be just as true at one time as at another. 
When we learn that Theodoric was proud of the 
beautiful cicatrices which he obtained without the 
use of any ointment, pulclierrimas cicatrices sine 
wiguento aliqiio inducebat, then further that he im 
pugned the use of poultices and of oils on wounds, 
while powders were too drying and besides had a 
tendency to prevent drainage, the literal meaning of 
the Latin words saniem incarcerare is to " in 
carcerate sanious material," it is easy to understand 
that the claim that antiseptic surgery was antici 
pated six centuries ago is no exaggeration and no 
far-fetched explanation with modern ideas in mind 
of certain clever modes of dressing hit upon acci 
dentally by medieval surgeons. 

Theodoric s treatment of many practical problems 
is interesting for the modern time. For instance, in 
his discussion of cancer he says that there are two 
forms of the affection. One of them is due to a 


melancholy humor, a constitutional tendency as it 
were, and occurs especially in the breasts of women 
or latent in the womb. This is difficult of treatment 
and usually fatal. The other class consists of a 
deep ulcer with undermined edges, occurring partic 
ularly on the legs, difficult to cure and ready of re 
lapse, but for which the outlook is not so bad. His 
description of noli me tangere and of lupus is rather 
practical. Lupus is " eating herpes," occurs mainly 
on the nose, or around the mouth, slowly increases, 
and either follows a preceding erysipelas or comes 
from some internal cause. Noli me tangere is a cor 
roding ulcer, so called perhaps because irritation of 
it causes it to spread more rapidly. He thinks that 
deep cauterization of it is the best treatment. Since 
these are in the department of skin diseases this 
seems the place to mention that Theodoric describes 
salivation as occurring after the use of mercury for 
certain skin diseases. He has already shown that 
he knows of certain genital ulcers and sores on the 
genital regions and of distinctions between them. 


The third of the great surgeons in northern Italy 
was William of Salicet. He was a pupil of Bruno s 
and the master of Lanfranc. The first part of his 
life was passed at Bologna and the latter part as the 
municipal and hospital physician of Verona. He 
probably died about 1280. He was a physician as 
well as a surgeon and was one of those who insisted 
that the two modes of practising medicine should not 
be separated, or if they were both medicine and 


surgery would suffer. He thought that the physician 
learned much by seeing the interior of the body dur 
ing life, while the surgeon was more conservative 
if he were a physician. It is curiously interesting 
to find that the Regius Professors at both Oxford 
and Cambridge in our time have expressed them 
selves somewhat similarly. Professor Clifford All- 
butt is quite emphatic in this matter and Professor 
Osier is on record to the same effect. Following 
Theodoric, William of Salicet did much to get away 
from the Arabic abuse of the cautery and brought 
the knife back to its proper place again as the ideal 
surgical instrument. Unlike those who had written 
before him, William quoted very little from preced 
ing writers. Whenever he quotes his contemporaries 
it is in order to criticise them. He depended on his 
own experience and considered that it was only w T hat 
he had actually learned from experience that he 
should publish for the benefit of others. 

A very good idea of the sort of surgery that Wil 
liam of Salicet practised may be obtained even from 
the beginning of the first chapter of his first book. 
This is all with regard to surgery of the head. He 
begins with the treatment of hydrocephalus or, as 
he calls it, water collected in the heads of children 
newly born." He rejects opening of the head by an 
incision because of the danger of it. In a number of 
cases, however, he had had success by puncturing the 
scalp and membranes with a cautery, though but a 
very small opening was made and the fluid was al 
lowed to escape only drop by drop. He then takes up 
eye diseases, a department of surgery rather well 
developed at that time, as can be seen from our 


account of the work of Pope John XXI as an oph 
thalmologist during the thirteenth century. See 
Ophthalmology (January, 1909), reprinted in 
" Catholic Churchmen in Science," Philadelphia, 
The Dolphin Press, 1909. 

William devotes six chapters to the diseases of 
the eyes and the eyelids. Then there are two chap 
ters on affections of the ears. Foreign bodies and 
an accumulation of ear wax are removed by means 
of instruments. A polyp is either cut off or its pedi 
cle bound with a ligature, and it is allowed to shrivel. 
The next chapter is on the nose. Nasal polyps were 
to be grasped with a sharp tenaculum, cum tenacillis 
acutis, and either wholly or partially extracted. 
Ranula was treated by being lifted well forward by 
means of a sharp iron hook and then split with a 
razor. It is evident that the tendency of these to fill 
up again was recognized, and accordingly it was 
recommended that vitriol powder, or alum with salt, 
be placed in the cavity for a time after evacuation 
in order to produce adhesive inflammation. 

In the same chapter on the mouth one finds that 
William did not hesitate to perform what cannot but 
be considered rather extensive operations within 
the oral cavity. For instance, he tells of removing 
a large epulis and gives an account in detail of the 
case. To quote his own words : " I cured a certain 
woman from Piacenza who was suffering from fleshy 
tumor on the gums of the upper jaw, the tumor hav 
ing grown to such a size above the teeth and the 
gums that it was as large or perhaps larger than a 
hen s egg. I removed it at four operations by 
means of heated iron instruments. At the last 


operation I removed the teeth that were loose with 
certain parts of the jawbone." 

In the next chapter there is an account of the treat 
ment of a remarkable case of abscess of the uvula. 
In the following chapter the swelling of cervical 
glands is taken up. In his experience expectant 
treatment of these was best. He advises internal 
medication with the building up of the general 
health, or suggests allowing the inflamed glands to 
empty themselves after pustulation. After much 
meddlesome surgery we are almost back to his meth 
ods again. He did not hesitate to treat goitre sur 
gically, though he considered there were certain in 
ternal remedies that would benefit it. In obstinate 
cases he suggests the complete extirpation of cystic 
goitre, but if the sac is allowed to remain it should 
be thoroughly rubbed over on the inside with green 
ointment. He warns about the necessity for avoid 
ing the veins and arteries in this operation, and says 
that " in this affection many large veins make their 
appearance and they find their way everywhere 
through the fleshy mass." 

What I have given here is to be found in a little 
more than half a page of Gurlt s abstract of the 
first twenty chapters of Salicet s first book. Alto 
gether Gurlt has more than ten pages of rather small 
print with regard to William; most of it is as inter 
esting and as practical and as representative of an 
ticipations of what is done in the modern time as 
what I have here quoted. William, as I have said, 
depended much more upon his own experience than 
upon what was to be found in text-books. He knew 
the old text-books very well however, but as a rule 


did not quote from them unless he had tried the 
recommendations for himself, or unless similar cases 
to these mentioned had come under his own observa 
tion. He was evidently a thoroughly observant phy 
sician, a skilled surgeon who was practical enough to 
see the simplest way to do things, and he proceeded 
to do them. It is no wonder that he influenced suc 
ceeding generations so much, nor that his great 
pupil, Lanfranc, continuing his tradition, founded a 
school of surgery in Paris, the influence of which 
was to endure almost down to our time, and give 
France a primacy in surgery until the nineteenth 


After Salicet s lifetime the focus of interest in 
surgery changes from Italy to France, and what is 
still more complimentary to William, it is through a 
favorite disciple of his that the change takes place. 
This was Lanfranchi, or Lanfranco, sometimes 
spoken of as Alanfrancus, who practised as phy 
sician and surgeon in Milan until banished from 
there by Matteo Visconti about 1290. He then went 
to Lyons, where in the course of his practice he 
attracted so much attention that he was offered the 
opportunity to teach surgery in Paris. He attracted 
what Gurlt calls an almost incredible number of 
scholars to his lessons in Paris, and by hundreds 
they accompanied him to the bedside of his patients 
and attended his operations. The dean of the med 
ical faculty, Jean de Passavant, urged him to write 
a text-book of surgery, not only for the benefit of 


his students at Paris but for the sake of the prestige 
which this would confer on the medical school. 
Deans still urge the same reasons for writing. Lan- 
franc completed his surgery, called " Chirurgia 
Magna," in 1296, and dedicated it to Philippe le Bel, 
the then reigning French King. Ten years later he 
died, but in the meantime he had transferred Italian 
prestige in surgery from Italy to France and laid 
the foundations in Paris of a thoroughly scientific 
as well as a practical surgery, though this depart 
ment of the medical school had been in a sadly 
backward state when he came. 

In the second chapter of this text-book, the first 
containing the definition of surgery and general in 
troduction, Lanfranc describes the qualities that in 
his opinion a surgeon should possess. He says, " It 
is necessary that a surgeon should have a temperate 
and moderate disposition. That he should have well- 
formed hands, long slender fingers, a strong body, 
not inclined to tremble and with all his members 
trained to the capable fulfilment of the wishes of 
his mind. He should be of deep intelligence and 
of a simple, humble, brave, but not audacious dis 
position. He should be well grounded in natural 
science, and should know not only medicine but every 
part of philosophy; should know logic well, so as to 
be able to understand what is written, to talk prop 
erly, and to support what he has to say by good rea 
sons." He suggests that it would be well for the 
surgeon to have spent some time teaching grammar 
and dialectics and rhetoric, especially if he is to 
teach others in surgery, for this practice will add 
greatly to his teaching power. Some of his expres- 


sions might well be repeated to young surgeons in 
the modern time. " The surgeon should not love 
difficult cases and should not allow himself to be 
tempted to undertake those that are desperate. He 
should help the poor as far as he can, but he 
should not hesitate to ask for good fees from the 

Many generations since Lanfranc s time have 
used the word nerves for tendons. Lanfranc, how 
ever, made no such mistake. He says that the 
wounds of nerres, since the nerve is an instrument 
of sense and motion, are, on account of the greater 
sensitiveness which these structures possess, likely 
to involve much pain. "Wounds along the length of 
the nerves are less dangerous than those across 
them. When a nerve is completely divided by a 
cross wound Lanfranc is of the opinion, though 
Theodoric and some others are opposed to it, that 
the nerve ends should be stitched together. He says 
that this suture insures the redintegration of the 
nerve much better. After this operation the restora 
tion of the usefulness of the member is more com 
plete and assured. 

His description of the treatment of the bite of a 
rabid dog is interesting. A large cupping glass 
should be applied over the wound so as to draw out 
as much blood as possible. After this the wound 
should be dilated and thoroughly cauterized to its 
depths with a hot iron. It should then be covered 
with various substances that were supposed to draw, 
in order as far as possible to remove the poison. 
His description of how one may recognize a rabid 
animal is rather striking in the light of our present 


knowledge, for he seems to have realized that the 
main diagnostic element is a change in the disposi 
tion of the animal, but above all a definite tendency 
to lack playfulness. Lanfranc had seen a number 
of cases of true rabies, and describes and suggests 
treatment for them, though evidently without very 
much confidence in the success of the treat 

The treatment of snake bites and the bites of other 
poisonous animals was supposed to follow the prin 
ciples laid down for the bite of a mad dog, especially 
as regards the encouragement of free bleeding and 
the use of the cautery. 

Lanfranc has many other expressions that one is 
tempted to quote, because they show a thinking sur 
geon of the old time, anticipating many supposedly 
modern ideas and conclusions. He is a particular 
favorite of Gurlt s, who has more than twenty-five 
large octavo, closely printed pages with regard to 
him. There is scarcely any development in our mod 
ern surgery that Lanfranc has not at least a hint of, 
certainly nothing in the surgery of a generation ago 
that does not find a mention in his book. On most 
subjects he has practical observations from his own 
experience to add to what was in surgical literature 
before his time. He quotes altogether more than 
a score of writers on surgery who had preceded 
him and evidently was thoroughly familiar with gen 
eral surgical literature. There is scarcely an impor 
tant surgical topic on which Gurlt does not find some 
interesting and personal remarks made by Lanfranc. 
All that w r e can do here is refer those who are inter 
ested in Lanfranc to Ms own works or Gurlt. 



The next of the important surgeons who were to 
bring such distinction to French surgery for five 
centuries was Henri de Mondeville. Writers usu 
ally quote him as Henricus. His latter name is only 
the place of his birth, which was probably not far 
from Caen in Normandy. It is spelled in so many 
different ways, however, by different writers that it 
is well to realize that almost anything that looks 
like Mondeville probably refers to him. Such vari 
ants as Mundeville, Hermondaville, Amondaville, 
Amundaville, Amandaville, Mandeville, Armanda- 
ville, Armendaville, Amandavilla occur. We owe 
a large amount of our information with re 
gard to him to Professor Pagel, who issued the 
first edition of his book ever published (Berlin, 
1892). It may seem surprising that Mondeville s 
work should have been left thus long without publica 
tion, but unfortunately he did not live long enough to 
finish it. He was one of the victims that tuberculosis 
claimed among physicians in the midst of their work. 
Though there are a great number of manuscript 
copies of his book, somehow Eenaissance interest in 
it in its incompleted state was never aroused suf 
ficiently to bring about a printed edition. Certainly 
it was not because of any lack of interest on the part 
of his contemporaries or any lack of significance in 
the work itself, for its printing has been one of the 
surprises afforded us in the modern time as showing 
how thoroughly a great writer on surgery did his 
work at the beginning of the fourteenth century. 


Gurlt, in his " History of Surgery," has given over 
forty pages, much of it small type, with regard to 
Mondeville, because of the special interest there is 
in his writing. 1 

His life is of particular interest for other reasons 
besides his subsequent success as a surgeon. He was 
another of the university men of this time who wan 
dered far for opportunities in education. Though 
born in the north of France and receiving his pre 
liminary education there, he made his medical stud 
ies towards the end of the thirteenth century under 
Theodoric in Italy. Afterwards he studied medicine 
in Montpellier and surgery in Paris. Later he gave 
at least one course of lectures at Montpellier himself 
and a series of lectures in Paris, attracting to both 
universities during his professorship a crowd of 
students from every part of Europe. One of his 
teachers at Paris had been his compatriot, Jean 
Pitard, the surgeon of Philippe le Bel, of whom he 
speaks as " most skilful and expert in the art of 
surgery," and it was doubtless to Pitard s friend 
ship that he owed his appointment as one of the four 
surgeons and three physicians who accompanied the 
King into Flanders. 

Besides his lectures, Mondeville had a large con 
sultant practice and also had to accompany the King 
on his campaigns. This made it extremely difficult 

1 Of course, for any extended knowledge of Mondeville, a modern 
reader must turn to Nicaise s translation of his "Chirurgia," which, 
with an introduction and a biography, was published at Paris in 1893. 
Nicaise s publication of this and of Guy de Chauliac s treatise has 
worked a revolution in medical history and, above all, has made 
these old authors available for those who hesitate to take up a work 
written entirely in Latin. 


for him to keep continuously at the writing of his 
book. It was delayed in spite of his good intentions, 
and we have the picture that is so familiar in the 
modern time of a busy man trying to steal or make 
time for his writing. Unfortunately, in addition to 
other obstacles, Mondeville showed probably before 
he was forty the first symptoms of a serious 
pulmonary disease, presumably tuberculosis. He 
bravely fought it and went on with his work. As his 
end approached he sketched in lightly what he had 
hoped to treat much more formally, and then turned 
to what was to have been the last chapter of his 
book, the Antidotarium or suggestions of practical 
remedies against diseases of various kinds because 
his students and physician friends were urging him 
to complete this portion for them. We of the modern 
time are much less interested in that than we would 
have been in some of the portions of the work that 
Mondeville neglected in order to provide therapeutic 
hints for his disciples. But then the students and 
young physicians have always clamored for the 
practical which so far at least in medical history 
has always proved of only passing interest. 

It is often said that at this time surgery was 
mainly in the hands of barbers and the ignorant. 
Henri de Mondeville, however, is a striking example 
in contradiction of this. He must have had a fine 
preliminary education and his book shows very wide 
reading. There is almost no one of any importance 
who seriously touched upon medicine or surgery be 
fore his time whom Mondeville does not quote. Hip 
pocrates, Aristotle, Dioscorides, Pliny, Galen, 
Khazes, AH Abbas, Abulcasis, Avicenna, Constan- 


tine Africanus, Averroes, Maimonides, Albertus 
Magnus, Hugo of Lucca, Theodoric, William of Sa- 
licet, Lanf ranc are all quoted, and not once or twice 
but many times. Besides he has quotations from 
the poets and philosophers, Cato, Diogenes, Horace, 
Ovid, Plato, Seneca, and others. He was a learned 
man, devoting himself to surgery. 

It is no wonder, then, that he thought that a sur 
geon should be a scholar, and that he needed to 
know much more than a physician. One of his char 
acteristic passages is that in which he declares " it 
is impossible that a surgeon should be expert who 
does not know not only the principles, but every 
thing worth while knowing about medicine," and 
then he added, " just as it is impossible for a man 
to be a good physician who is entirely ignorant of 
the art of surgery." He says further: " This our 
art of surgery, which is the third part of medicine 
(the other two parts were diet and drugs), is, with 
all due reverence to physicians, considered by us 
surgeons ourselves and by the non-medical as a 
more certain, nobler, securer, more perfect, more 
necessary, and more lucrative art than the other 
parts of medicine." Surgeons have always been 
prone to glory in their specialty. 

Mondeville had a high idea of the training that 
a surgeon should possess. He says: "A surgeon 
who wishes to operate regularly ought first for a 
long time to frequent places in which skilled sur 
geons operate often, and he ought to pay careful 
attention to their operations and commit their tech 
nique to memory. Then he ought to associate him 
self with them in doing operations. A man cannot 


be a good surgeon unless he knows both the art and 
science of medicine and especially anatomy. The 
characteristics of a good surgeon are that he should 
be moderately bold, not given to disputations before 
those who do not know medicine, operate with fore 
sight and wisdom, not beginning dangerous opera 
tions until he has provided himself with everything 
necessary for lessening the danger. He should have 
well-shaped members, especially hands with long, 
slender fingers, mobile and not tremulous, and with 
all his members strong and healthy so that he may 
perform all the good operations without disturb 
ance of mind. He must be highly moral, should care 
for the poor for Grod s sake, see that he makes him 
self well paid by the rich, should comfort his pa 
tients by pleasant discourse, and should always ac 
cede to their requests if these do not interfere with 
the cure of the disease." " It follows from this," 
he says, " that the perfect surgeon is more than the 
perfect physician, and that while he must know medi 
cine he must in addition know his handicraft." 

Thinking thus, it is no wonder that he places his 
book under as noble patronage as possible. He says 
in the preface that he " began to write it for the 
honor and praise of Christ Jesus, of the Virgin Mary, 
of the Saints and Martyrs, Cosmas and Damian, and 
of King Philip of France as well as his four chil 
dren, and on the proposal and request of Master 
William of Briscia, distinguished professor in the 
science of medicine and formerly physician to Pope 
Boniface TV and Benedict and Clement, the present 
Pope." His first book on anatomy he proposed to 
found on that of Avicenna and " on his personal ex- 


perience as he has seen it." The second tractate on 
the treatments of wounds, contusions, and ulcers 
was founded on the second book of Theodoric " with 
whatever by recent study has been newly acquired 
and brought to light through the experience of mod 
ern physicians." He then confesses his obligations 
to his great master, John Pitard, and adds that all 
the experience that he has gained while operating, 
studying, and lecturing for many years on surgery 
will be made use of in order to enhance the value 
of the work. He hopes, however, to accomplish all 
this " briefly, quietly, and above all, charitably." 
There are many things in the preface that show us 
the reason for Mondeville s popularity, for they ex 
hibit him as very sympathetically human in his in 

While Mondeville is devoted to the principle that 
authority is of great value, he said that there was 
nothing perfect in things human, and successive gen 
erations of younger men often made important addi 
tions to what their ancestors had left them. While 
his work is largely a compilation, nearly everywhere 
it shows signs of the modification of his predecessors 
opinions by the results of his own experience. His 
method of writing is, as Pagel declares, always in 
teresting, lively, and often full of meat. He had a 
teacher s instinct, for in several of the earlier manu 
scripts his special teaching is put in larger letters 
in order to attract students attention. . . He seems 
to have introduced or re-introduced into practice the 
idea of the use of a large magnet in order to extract 
portions of iron from the tissues. He made several 
modifications in needles and thread holders and in- 


vented a kind of small derrick for the extraction of 
arrows with barbs. Besides, he suggested the sur 
rounding of the barbs of the arrows with tubes, to 
facilitate extraction. In his treatment of wounds, 
Pagel considers that as a writer and teacher he is 
far ahead of his predecessors and even of those who 
came after him in immediately subsequent genera 
tions. One of his great merits undoubtedly is that 
Guy de Chauliac, the father of modern surgery, in 
his test-book turned to him with a confidence that 
proclaims his admiration and how much he felt that 
he had gained from him. 

One of the most interesting features of Monde- 
ville s work is his insistence on the influence of the 
mind on the body and the importance of using this 
influence to the best advantage. It is especially im 
portant in Mondeville s opinion to keep a surgical 
patient from being moody. Let the surgeon, says 
he, take care to regulate the whole regimen of the 
patient s life for joy and happiness by promising 
that he will soon be well, by allowing his relatives 
and special friends to cheer him and by having some 
one to tell him jokes, and let him be solaced also by 
music on the viol or psaltery. The surgeon must 
forbid anger, hatred, and sadness in the patient, and 
remind him that the body grows fat from joy and 
thin from sadness. He must insist on the patient 
obeying him faithfully in all things. He repeats with 
approval the expression of Avicenna that " often the 
confidence of the patient in his physician does more 
for the cure of his disease than the physician with 
all his remedies." Obstinate and conceited patients 
prone to object to nearly everything that the sur- 


geon wants to do, and who often seem to think that 
they surpass Galen and Hippocrates in science and 
wisdom, are likely to delay their cure very much, and 
they represent the cases with which the surgeon has 
much difficulty. 

Mondeville thought that nursing was extremely 
important and that without it surgery often failed 
of its purpose. He says, " For if the assistants are 
not solicitous and faithful, and obedient to the sur 
geons in each and every thing which may make for 
the cure of the disease, they put obstacles and diffi 
culties in the way of the surgeon." It is especially 
important that the patient s nutrition should be 
cared for and that the bandages should be managed 
exactly as the surgeon directs. He has no use for 
garrulous, talkative nurses, and does not hesitate to 
say that sometimes near relatives are particularly 
likely to disturb patients. " Especially are they prone 
to let drop some hint of bad news which the surgeon 
may have revealed to them in secret, or even the 
reports that they may hear from others, friends or 
enemies, and this provokes the patient to anger or 
anxiety and is likely to give him fever. If the as 
sistants quarrel among themselves, or are heard mur 
muring, or if they draw long faces, all of these 
things will disturb the patients and produce worry 
and anxiety or fear. The surgeon therefore must be 
careful in the selection of his nurses, for some of 
them obey very well while he is present, but do as 
they like and often just exactly the opposite of what 
he has directed when he is away." 

We do not know enough of the details of Monde 
ville s life to be sure whether he was married or not. 


It is probable that he was not, for all of these sur 
geons of the thirteenth century before Mondeville s 
time, Theodoric, William of Salicet, Lanfranc, and 
Guy de Chauliac, after him belonged to the clerical 
order; Theodoric was a bishop; the others, how 
ever, seem only to have been in minor orders. It 
is therefore from the standpoint of a man who views 
married life from without that Mondeville makes his 
remarks as to the difficulty often encountered when 
wives nurse their husbands. He says that the sur 
geon has difficulty oftener when husbands or wives 
care for their spouses than at other times. This is 
much more likely to take place when the wives are 
caring for the husbands. " In our days," he says, 
" in this Gallican part of the world, wives rule their 
husbands, and the men for the most part permit 
themselves to be ruled. Whatever a surgeon may 
order for the cure of a husband then will often seem 
to the wives to be a waste of good material, though 
the men seem to be quite willing to get anything that 
may be ordered for the cure of their wives. The 
whole cause of this seems to be that every woman 
seems to think that her husband is not as good as 
those of other women whom she sees around her." 
It would be interesting to know how Mondeville was 
brought to a conclusion so different from modern 
experience in the matter. 

For those who are particularly interested in med 
ical history one of the sections of Henry s book has 
a special appeal, because he gives in it a sketch of 
the history of surgery. We are little likely to think, 
as a rule, that at this time, full two centuries before 
the close of the Middle Ages, men were interested 


enough in the doings of those who had gone before 
them to try to trace the history of the development of 
their specialty. It is characteristic of the way that 
the scholarly Mondeville views his own life work 
that he should have wanted to know something about 
his predecessors and teach others with regard to 
them. He begins with Galen, and as Galen divides 
the famous physicians of the world into three sects, 
the Methodists, the Empirics, and the Rationalists, 
so Mondeville divides modern surgery into three 
sects : first, that of the Salernitans, with Roger, 
Roland, and the Four Masters ; second, that of Wil 
liam of Salicet and Lanfranc; and third, that of 
Hugo de Lucca and his brother Theodoric and their 
modern disciples. He states briefly the characteris 
tics of these three sects. The first limited patients 
diet, used no stimulants, dilated all wounds, and got 
union only after pus formation. The second allowed 
a liberal diet to \veak patients, though not to the 
strong, but generally interfered with wounds too 
much. The third believed in a liberal diet, never di 
lated wounds, never inserted tents, and its members 
were extremely careful not to complicate wounds of 
the head by unwise interference. His critical dis 
cussion of the three schools is extremely interesting. 
Another phase of Mondeville s work that is sym 
pathetic to the moderns is his discussion of the ir 
regular practice of medicine and surgery as it existed 
in his time. Most of our modern medicine and sur 
gery was anticipated in the olden time; but it may 
be said that all of the modes of the quack are as old 
as humanity. Galen s description of the travelling 
charlatan who settled down in his front yard, not 


knowing that it belonged to a physician, shows this 
very well. There were evidently as many of them 
and as many different kinds in Mondeville s time as 
in our own. In discussing the opposition that had 
arisen between physicians and surgeons in his time 
and their failure to realize that they were both mem 
bers of a great profession, he enumerates the many 
different kinds of opponents that the medical profes 
sion had. There were " barbers, soothsayers, loan 
agents, falsifiers, alchemists, meretrices, rnidwives, 
old women, converted Jews, Saracens, and indeed 
most of those who, having wasted their substance 
foolishly, now proceed to make physicians or sur 
geons of themselves in order to make their living 
under the cloak of healing." 

What surprises Mondeville however, as it has al 
ways surprised every physician who knows the sit 
uation, is that so many educated, or at least sup 
posedly well-informed people of the better classes, 
indeed even of the so-called best classes, allow them 
selves to be influenced by these quacks. And it is 
even more surprising to him that so many well-to-do, 
intelligent people should, for no reason, though with 
out knowledge, presume to give advice in medical 
matters and especially in even dangerous surgical 
diseases, and in such delicate affections as diseases 
of the eyes. " It thus often happens that diseases 
in themselves curable grow to be simply incurable or 
are made much worse than they were before." He 
says that some of the clergymen of his time seemed 
to think that a knowledge of medicine is infused into 
them with the sacrament of Holy Orders. He was 
himself probably a clergyman, and I have in the 


modern time more than once known of teachers in 
the clerical seminaries emphasizing this same idea 
for the clerical students. It is very evident that the 
world has not changed very much, and that to know 
any time reasonably well is to find in it comments 
on the morning paper. We are in the midst of just 
such a series of interferences with medicine on the 
part of the clergy as this wise, common-sense sur 
geon of the thirteenth century deprecated. 

In every way Mondeviile had the instincts of a 
teacher. He took advantage of every aid. He was 
probably the first to use illustrations in teaching 
anatomy. Guy de Chauliac, whose teacher in anat 
omy for some time Mondeviile was, says in the first 
chapter of his " Chirurgia Magna " that pictures 
do not suffice for the teaching of anatomy and that 
actual dissection is necessary. The passage runs 
as follows: " In the bodies of men, of apes, and of 
pigs, and of many other animals, tissues should be 
studied by dissections and not by pictures, as did 
Henricus, who was seen to demonstrate anatomy 
with thirteen pictures." 1 What Chauliac blames is 
the attempt to replace dissections by pictorial de 
monstrations. Hyrtl, however, suggests that this in 
vention of Mondeviile s was probably very helpful, 
and was brought about by the impossibility of pre- 

1 In the very first book containing some account of human anatomy, 
a German volume by Conradus Mengenberger, called " Puch der Na- 
tur," the date of printing of which is about 1478, that is, less than ten 
years after the printing of the very first book, the "Bibliapauperum," 
which appeared in 1470, there are, according to Haller in his "Biblio- 
theca Anatomica," a series of illustrations. This is the first illustrated 
medical work ever published. 


serving bodies for long periods as well as the dif 
ficulty of obtaining them. 


One of the maxims of the old Greek philosophers 
was that good is diffusive of itself. As the scholas 
tics put it, bonum est diffu-sivum sui. This proved 
to be eminently true of the old universities also, and 
especially of their training in medicine and in sur 
gery. We have the accounts of men from many na 
tions who went to the universities and returned to 
benefit their own people. Early in the thirteenth cen 
tury Richard the Englishman was in Italy, having 
previously been in Paris and probably atMontpellier. 
Bernard Gordon, probably also an Englishman, was 
one of the great lights in medicine down at Mont- 
pellier, and his book, " Lilium De Medicina," is well 
known. Two distinguished surgeons whose names 
have come down to us, having studied in Paris after 
Lanfranc had created the tradition of great surgical 
teaching there, came to their homes to be centres of 
beneficent influence among their people in this mat 
ter. One was Yperman, of the town of Ypres in 
Belgium ; the other Ardern of England. Ypermann 
was sent by his fellow-townsmen to Paris in order 
to study surgery, because they wanted to have a 
good surgeon in their town and Paris seemed the 
best school at that time. Ypres was at this period 
one of the greatest commercial cities of Europe, and 
probably had a couple of hundred thousand inhab 
itants. The great hall of the cloth gild, which has 
been such an attraction for visitors ever since, was 


built shortly before the town determined upon the 
very sensible procedure of securing good surgery 
beyond all doubt by having a townsman specially 
educated for that purpose. 

Yperman s work was practically unknown to us 
until Broeck, the Belgian historian, discovered man 
uscript copies of his book on surgery and gath 
ered some details of his life. After his return from 
Paris, Yperman obtained great renown, which 
maintained itself in the custom extant in that 
part of the country even yet of calling an expert 
surgeon an Yperman. He is the author of two 
works in Flemish. One of these is a smaller com 
pendium of internal medicine, which is very inter 
esting, however, because it shows the many subjects 
that were occupying physicians minds at that time. 
He treats of dropsy, rheumatism, under which occur 
the terms coryza and catarrh (the flowing diseases), 
icterus, phthisis (he calls the tuberculosis, tysiken), 
apoplexy, epilepsy, frenzy, lethargy, fallen palate, 
cough, shortness of breath, lung abscess, hemor 
rhage, blood-spitting, liver abscess, hardening of the 
spleen, affections of the kidney, bloody urine, dia 
betes, incontinence of urine, dysuria, strangury, 
gonorrhea, and involuntary seminal emissions all 
these terms are quoted directly from Pagel s ac 
count of his work; the original is not available in 
this country. 


In English-speaking countries of course we are in 
terested in what was done by Englishmen at this 


time. Fortunately we have the record of one great 
English surgeon of the period worthy to be placed 
beside even the writers already mentioned. This 
is John Ardern, whose name is probably a modifica 
tion of the more familiar Arden, whose career well 
deserves attention. I have given a sketch of his 
work in " The Popes and Science." 1 He was edu 
cated at Montpellier, and practised surgery for a 
time in France. About the middle of the century how 
ever, according to Pagel, he went back to his native 
land and settled for some twenty years at Newark, 
in Nottinghamshire, and then for nearly thirty years 
longer, until about the end of the century, was in 
London. He is the chief representative of English 
surgery during the Middle Ages. His " Practica," 
as yet unprinted, contains, according to Pagel, a 
short sketch of internal medicine, but is mainly de 
voted to surgery. Contrary to the usual impression 
with regard to works in medicine and surgery at 
this time, the book abounds in references to case his 
tories which Ardern had gathered, partly from his 
own and partly from others experience. The thera 
peutic measures that he suggests are usually very 
simple, in the majority of cases quite rational, 
though, of course, there are many superstitions 
among them; but Ardern always furnished a num 
ber of suggestions from which to choose. He must 
have been an expert operator, and had excellent suc 
cess in the treatment of diseases of the rectum. He 
seems to have been the first operator who made 
careful statistics of his cases, and was quite as proud 

^ordham University Press, New York, 1908. 


as any modern surgeon of the large numbers that 
he had operated on, which he gives very exactly. 
He was the inventor of a new clyster apparatus. 

Fortunately we possess here in America, in the 
Surgeon General s Library at "Washington, a very 
interesting manuscript containing Ardern s surgical 
writings, though it has not yet been published. Even 
a little study of this and of the notes on it prepared 
by an English bibliophile before its purchase by the 
Surgeon General s Library, serves to show how val 
uable the work is in the history of surgery. There 
are illustrations scarcely less interesting than the 
text. Some of these illustrations were inserted by 
the original writer or copyist, and some of them later. 
In general, however, they show a rather high devel 
opment of the mechanics of surgery at that time. 
Some of the pages have spaces for illustrations left 
unfilled, so that evidently the copyist did not com 
plete his work. The titles of certain of the chapters 
are interesting, as illustrating the fact that our 
medical and surgical problems were stated clearly 
in the olden time, and thinking physicians, even six 
centuries ago, met them quite rationally. There is, 
for instance, a chapter headed " Against Colic and 
the Iliac Passion," immediately followed by the sub 
heading, " Method of Administering Clysters." 
The iliac passion, passio iliaca of the old Latin, is 
usually taken to signify some obstruction of the in 
testines causing severe pain, vomiting, and eventu 
ally fecal vomiting. A good many different forms 
of severe painful conditions, especially all those com 
plicated by peritonitis, were included under the term, 
and the modern student of surgery is likely to won- 


der whether these old observers had not noted that 
the right iliac region was particularly psone to be 
the source of fatal conditions. There is a chapter 
entitled " Against Pain in the Loins and the Kid 
neys," followed by the chapter subheading, 
" Against Stone in the Kidneys." There is a chap 
ter with the title, Against Ulceration of the Blad 
der or the Kidneys." Another one, with the title 
" Against Burning of the Urine and Excoriation of 
the Lower Part of the Yard." Gonorrhea is frankly 
treated under the name Sliawdepisse, evidently an 
English alliteration of the corresponding French 
word. As to the instrumentation of such conditions 
and for probing in general, Ardern suggests the use 
of a lead probe, because it may readily be made to 
bend any way and not injure the tissues. 


Even this brief account of the surgeons who taught 
and studied at the medieval universities demon 
strates what fine work they did. It is surely not too 
much to say that the chapter on university educa 
tion mainly concerned with them is one of the most 
interesting in the whole history of the universities. 
Their story alone is quite enough to refute most of 
the prevalent impressions and patronizing expres 
sions with regard to medieval education. Their 
careers serve to show how interested were the men 
of many nations in the development of an extremely 
important application of science for the benefit of 
suffering humanity. Their work utterly contradicts 
the idea so frequently emphasized that the great 


students of the Middle Ages were lacking in prac 
ticalness. Besides, they make very clear that we 
have been prone to judge the Middle Ages too much 
from its speculative philosophies. It has been the 
custom to say that speculation ruled men s minds 
and prevented them from making observations, de 
veloping science, or applying scientific principles. 
There was much speculation during the Middle Ages, 
but probably not any more in proportion than exists 
at the present day. We were either not acquainted 
with, or failed to appreciate properly, until com 
paratively recent years, the other side of medieval 
accomplishment. Our ignorance led us into misun 
derstanding of what these generations really did. It 
was our own fault, because during the Eenaissance 
practically all of these books were edited and printed 
under the direction cf the great scholars of the time 
in fine editions, but during the eighteenth century 
nearly all interest was lost in them, and we are only 
now beginning to get back a certain amount of the 
precious knowledge that they had in the Renaissance 
period of this other side of medieval life. We have 
learned so much about surgery because distinguished 
scholars devoted themselves to this phase of the his 
tory of science. Doubtless there are many other 
phases of the history of science which suffered the 
same fate of neglect and with regard to which the 
future will bring us equally startling revelations. 
For this reason this marvellous chapter in the his 
tory of surgery is a warning as well as a startling 
record of a marvellous epoch of human progress. 



One of the most interesting characters in the his 
tory of medieval medicine, and undoubtedly the most 
important and significant of these Old-Time Makers 
of Medicine, is Guy de Chauliac. Most of the false no 
tions so commonly accepted with regard to the Mid 
dle Ages at once disappear after a careful study of 
his career. The idea of the careful application of 
scientific principles in a great practical way is far 
removed from the ordinary notion of medieval pro 
cedure. Some observations we may concede that 
they did make, but we are inclined to think that these 
were not regularly ordered and the lessons of them 
not drawn so as to make them valuable as experi 
ences. Great art men may have had, but science and, 
above all, applied science, is a later development of 
humanity. Particularly is this supposed to be true 
with regard to the science and practice of surgery, 
which is assumed to be of comparatively recent 
origin. Nothing could well be less true, and if the 
thoroughly practical development of surgery may be 
taken as a symbol of how capable men were of apply 
ing science and scientific principles, then it is com 
paratively easy to show that the men of the later 
Middle Ages were occupied very much as have been 
our recent generations with science and its practical 


The immediate evidence of the value of old-time 
surgery is to be found in the fact that Guy de 
Chauliac, who is commonly spoken of in the history 
of medicine as the Father of Modern Surgery, lived 
his seventy-odd years of life during the fourteenth 
century and accomplished the best of his work, 
therefore, some five centuries before surgery in our 
modern sense of the term is supposed to have de 
veloped. A glance at his career, however, will show 
how old are most of the important developments 
of surgery, as also in what a thoroughly scientific 
temper of mind this subject was approached more 
than a century before the close of the Middle Ages. 
The life of this French surgeon, indeed, who was a 
cleric and occupied the position of chamberlain and 
physician-in-ordinary to three of the Avignon Popes, 
is not only a contradiction of many of the tradi 
tions as to the backwardness of our medieval for 
bears in medicine, that are readily accepted by many 
presumably educated people, but it is the best pos 
sible antidote for that insistent misunderstanding of 
the Middle Ages which attributes profound igno 
rance of science, almost complete failure of observa 
tion, and an absolute lack of initiative in applica 
tions of science to the men of those times. 

Guy de Chauliac s life is modern in nearly every 
phase. He was educated in a little town of the 
south of France, made his medical studies at Mont- 
pellier, and then went on a journey of hundreds of 
miles into Italy, in order to make his post-graduate 
studies. Italy occupied the place in science at that 
time that Germany has taken during the nineteenth 
century. A young man who wanted to get into touch 


with the great masters in medicine naturally went 
down into the Peninsula. Traditions as to the atti 
tude of the Church to science notwithstanding, Italy 
where education was more completely under the 
influence of the Popes and ecclesiastics than in any 
other country in Europe, continued to be the home 
of post-graduate work in science for the next four 
centuries. Almost needless to say, the journey to 
Italy was more difficult of accomplishment and in 
volved more expense and time than would even the 
voyage from America to Europe in our time. Chau- 
liac realized, however, that both time and expense 
would be well rewarded, and his ardor for the round 
ing out of his education was amply recompensed 
by the event. Nor have we any reason for thinking 
that what he did was very rare, much less unique, 
in his time. Many a student from France, Germany, 
and England made the long journey to Italy for 
post-graduate opportunities during the later Middle 

Even this post-graduate experience in Italy did 
not satisfy Chauliac, however, for, after having 
studied several years with the most distinguished 
Italian teachers of anatomy and surgery, he spent 
some time in Paris, apparently so as to be sure that 
he would be acquainted with the best that was being 
done in his specialty in every part of the world. He 
then settled down to his own life work, carrying his 
Italian and French masters teachings well beyond 
the point where he received them, and after years 
of personal experience he gathered together his 
masters ideas, tested by his own observations, into 
his " Chirurgia Magna," a great text-book of sur- 


gery which sums up the whole subject succinctly, 
yet completely, for succeeding generations. When 
we talk about what he accomplished for surgery, we 
are not dependent on traditions nor vague informa 
tion gleaned from contemporaries and successors, 
who might perhaps have been so much impressed 
by his personality as to be made over-enthusiastic 
in their critical judgment of him. "We know the man 
in his surgical works, and they have continued to be 
classics in surgery ever since. It is an honorable 
distinction for the medicine of the later fourteenth, 
the fifteenth, and sixteenth centuries that Guy de 
Chauliac s book was the most read volume of the 
time in medicine. Evidently the career of such a 
man is of import, not alone to physicians, but to all 
who are interested in the history of education. 

Chauliac derives his name from the little town 
of Chauliac in the diocese of Mende, almost in the 
centre of what is now the department of Lozere. 
The records of births and deaths were not consid 
ered so important in the fourteenth century as they 
are now, and so we are not sure of either in the case 
of Chauliac. It is usually considered that he was 
born some time during the last decade of the thir 
teenth century, probably toward the end of it, and 
that he died about 1370. Of his early education we 
know nothing, but it must have been reasonably 
efficient, since it gave him a good working knowledge 
of Latin, which was the universal language of science 
and especially of medicine at that time ; and though 
his own style, as must be expected, is no better than 
that of his contemporaries, he knew how to express 
his thoughts clearly in straightforward Latin, with 


only such a mixture of foreign terms as his studies 
suggested and the exigencies of a new development 
of science almost required. Later in life he seems 
to have known Arabic very well, for he is evidently 
familiar with Arabian books and does not depend 
merely on translations of them. 

Pagel, in the first volume of Puschmann s " Hand 
book of the History of Medicine," says, on the 
authority of Nicaise and others, that Chauliac re 
ceived his early education from the village clergy 
man. His parents were poor, and but for ecclesi 
astical interest in him it would have been difficult 
for him to obtain his education. The Church sup 
plied at that time to a great extent for the founda 
tions and scholarships, home and travelling, of our 
day, and Chauliac was amongst the favored ones. 
How well he deserved the favor his subsequent 
career shows, as it completely justifies the judg 
ment of his patrons. He went first to Toulouse, as 
we know from his affectionate mention of one of his 
teachers there. Toulouse was more famous for law, 
however, than for medicine, and after a time Chau 
liac sought Montpellier to complete his medical 

For English-speaking people an added interest in 
Guy de Chauliac will be the fact that one of his 
teachers at Montpellier was Bernard Gordon, very 
probably a Scotchman, who taught for some thirty- 
five years at this famous university in the south of 
France, and died near the end of the first quarter 
of the fourteenth century. One of Chauliac s fellow- 
students at Montpellier was John of Gaddesden, the 
first English Royal Physician by official appoint- 


ment of whom we have any account. John is men 
tioned by Chaucer in his " Doctor of Physic," and 
is usually looked upon as one of the fathers of Eng 
lish medicine. Chauliac did not think much of him, 
though his reason for his dislike of him will prob 
ably be somewhat startling to those who assume that 
the men of the Middle Ages always clung servilely 
to authority. Chauliac s objection to Gaddesden s 
book is that he merely repeats his masters and does 
not dare to think for himself. It is not hard to 
understand that such an independent thinker as 
Chauliac should have been utterly dissatisfied with 
a book that did not go beyond the forefathers in 
medicine that the author quotes. This is the ex 
planation of his well-known expression, " Last of all 
arose the scentless rose of England [ Kosa An- 
gliae was the name of John of Gaddesden s book], 
in which, on its being sent to me, I hoped to find the 
odor of sweet originality, but instead of that I en 
countered only the fictions of Hispanus, of Gilbert, 
and of Theodoric." 

The presence of a Scotch professor and an Eng 
lish fellow-student, afterwards a royal physician, at 
Montpellier, at the beginning of the fourteenth cen 
tury, shows how much more cosmopolitan was uni 
versity life in those times than we are prone to 
think, and what attraction a great university medical 
school possessed even for men from long distances. 

After receiving his degree of Doctor of Medicine 
at Montpellier Chauliac went, as we have said, to 
Bologna. Here he attracted the attention and re 
ceived the special instruction of Bertruccio, who 
was attracting students from all over Europe at 


this time and was making some excellent demonstra 
tions in anatomy, employing human dissections very 
freely. Chauliac tells of the methods that Bertruc- 
cio used in order that bodies might be in as good 
condition as possible for demonstration purposes, 
and mentions the fact that he saw him do many dis 
sections in different ways. 

In Roth s life of Vesalius, which is usually con 
sidered one of our most authoritative medical his 
torical works not only with regard to the details of 
Vesalius life, but also in all that concerns anatomy 
about that time and for some centuries before, there 
is a passage quoted from Chauliac himself which 
shows how freely dissection was practised at the 
Italian universities in the fourteenth century. This 
passage deserves to be quoted at some length be 
cause there are even serious historians who still 
cite a Bull of Pope Boniface VIII, issued in 1300, 
forbidding the boiling and dismembering of bodies 
in order to transport them to long distances for 
burial in their own country, as being, either rightly 
or wrongly, interpreted as a prohibition of dissec 
tion and, therefore, preventing the development of 
anatomy. In the notes to his history of dissection 
during this period in Bologna Roth says: " Without 
doubt the passage in Guy de Chauliac which tells 
of having frequently seen dissections, must be con 
sidered as referring to Bologna. This passage runs 
as follows : My master Bertruccius conducted the 
dissection very often after the following manner: 
the dead body having been placed upon a bench, he 
used to make four lessons on it. In the first the 
nutritional portions were treated, because they are 


so likely to become putrefied. In the second, he 
demonstrated the spiritual members; in the third, 
the animate members; in the fourth, the extrem 
ities. " (Roth, " Andreas Vesalius." Basel, 1896.) 
Bertruccio s master, Mondino, is hailed in the his 
tory of medicine as the father of dissection. His 
book on dissection was for the next three centuries 
in the hands of nearly every medical scholar in 
Europe who was trying to do good work in anatomy. 
It was not displaced until Vesalius came, the father 
of modern anatomy, who revolutionized the science 
in the Renaissance time. Mondino had devoted him 
self to the subject with unfailing ardor and enthusi 
asm, and from everywhere in Europe the students 
came to receive inspiration in his dissecting-room. 
Within a few years such was the enthusiasm for dis 
section aroused by him in Bologna that there were 
many legal prosecutions for body-snatching, the con 
sequence doubtless of a regulation of the Medical 
Department of the University of Bologna, that if 
the students brought a body to any of their teachers 
he was bound to dissect it for them. Bertruccio, 
Mondino s disciple and successor, continued this 
great work, and now Chauliac, the third in the tradi 
tion, was to carry the Bolognese methods back to 
France, and his position as chamberlain to the Pope 
was to give them a wide vogue throughout the world. 
The great French surgeon s attitude toward anat 
omy and dissection can be judged from his famous 
expression that " the surgeon ignorant of anatomy 
carves the human body as a blind man carves 
wood." The whole subject of dissection at this time 
has been fully discussed in the first three chapters 


of my " Popes and Science," where those who are 
interested in the matter may follow it to their satis 
faction. 1 

After his Bologna experience Chauliac went to 
Paris. Evidently his indefatigable desire to know 
all that there was to be known would not be satisfied 
until he had spent some time at the great French 
university where Lanfranc, after having studied 
under William of Salicet in Italy, had gone to estab 
lish that tradition of French surgery which, carried 
on so well by Mondeville his great successor, was 
to maintain Frenchmen as the leading surgeons of 
the world until the nineteenth century (Pagel). 
Lanfranc, himself an Italian, had been exiled from 
his native country, apparently because of political 
troubles, but was welcomed at Paris because the 
faculty realized that they needed the inspiration of 
the Italian medical movement in surgery for the es 
tablishment of a good school of surgery in connec 
tion with the university. The teaching so well begun 
by Lanfranc was magnificently continued by Monde 
ville and Arnold of Villanova and their disciples. 
Chauliac was fortunate enough to come under the 
influence of Petrus de Argentaria, who was worthily 
maintaining the tradition of practical teaching in 
anatomy and surgery so well founded by his great 
predecessors of the thirteenth century. After this 
grand tour Chauliac was himself prepared to do 
work of the highest order, for he had been in touch 
with all that was best in the medicine and surgery 
of his time. 

3 FordLam University Press, New York, 1908. 


Like many another distinguished member of his 
profession, Chauliac did not settle down in the scene 
of his ultimate labors at once, but was something of 
a wanderer. His own words are, " Et per midta 
tempora operatus fui in mult is partibus." Perhaps 
out of gratitude to the clerical patrons of his native 
town to whom he owed so much, or because of the 
obligations he considered that he owed them for his 
education, he practised first in his native diocese of 
Mende ; thence he removed to Lyons, where we know 
that he lived for several years, for in 1344 he took 
part as a canon in a chapter that met in the Church 
of St. Just in that city. Just when he was called 
to Avignon we do not know, though when the black 
death ravaged that city in 1348 he was the body- 
physician of Pope Clement VI, for he is spoken of 
in a Papal document as " venerabilis et circum- 
spectus vir, dominus Guido de Caidiaco, canonicus et 
prcepositus ecclesia Sancti Justi Lugduni, medi- 
cusque domini Nostri Pap<z." All the rest of his 
life was passed in the Papal capital, which Avignon 
was for some seventy years of the fourteenth cen 
tury. He served as chamberlain-physician to three 
Popes, Clement VI, Innocent VI, and Urban V. We 
do not know the exact date of his death, but when 
Pope Urban V went to Eome in 1367, Chauliac was 
putting the finishing touches on his " Chirurgia 
Magna," which, as he tells us, was undertaken as a 
solatium senectutis a solace ijn old age. "When 
Urban returned to Avignon for a time in 1370 
Chauliac was dead. His life work is summed up for 
us in this great treatise on surgery, full of anticipa- 


tions in surgical procedures that we are prone to 
think much more modern, 

Xicaise has emphasized the principles which 
guided Guy de Chauliac in the choice and interpreta 
tion of his authorities by a quotation from Guy 
himself, which is so different in its tone from what 
is usually supposed to have been the attitude of mind 
of the men of science of the time that it would be 
well for all those who want to understand the Mid 
dle Ages better to have it near them. Speaking of 
the surgeons of his own and immediately preceding 
generations, Guy says: " One thing particularly is 
a source of annoyance to me in what these surgeons 
have written, and it is that they follow one another 
like so many cranes. For one always says what the 
other says. I do not know whether it is from fear 
or from love that they do not deign to listen except 
to such things as they are accustomed to and as 
have been proved by authorities. They have to my 
mind understood very badly Aristotle s second book 
of metaphysics where he shows that these two 
things, fear and love, are the greatest obstacles on 
the road to the knowledge of the truth. Let them 
give up such friendships and fears. Because while 
Socrates or Plato may be a friend, truth is a 
greater friend. Truth is a holy thing and worthy 
to be honored above everything else. Let them fol 
low the doctrine of Galen, which is entirely made 
up of experience and reason, and in which one in 
vestigates things and despises words." 

After all, this is what great authorities in medi 
cine have always insisted on. Once every hundred 
years or so one finds a really great observer who 


makes new observations and wakes the world up. 
He is surprised that men should not have used their 
powers of observation for themselves, but should 
have been following old-time masters. His corn- 
temporaries often refuse to listen to him at first. 
His observations, however, eventually make their 
way. We blame the Middle Ages for following au 
thority, but what have we been always doing but 
following authority, except for the geniuses who 
come and lift us out of the rut and illuminate a new 
portion of the realm of medicine. After they have 
come, however, and done their work, their disciples 
proceed to see with their eyes and to think that they 
are making observations for themselves when they 
are merely following authority. When the next mas 
ter in medicine comes along his discovery is neg 
lected because men have not found it in the old 
books, and usually he has to suffer for daring to 
have opinions of his own. The fact of the matter 
is that at any time there is only a very limited num 
ber of men who think for themselves. The rest think 
other people s thoughts and think they are thinking 
and doing things. As for observation, John Kuskin 
once said, Nothing is harder than to see something 
and tell it simply as you saw it." This is as true in 
science as in art, and only genius succeeds in doing 
it well. 

Chauliac s book is confessedly a compilation. He 
has taken the good wherever he found it, though he 
adds, modestly enough, that " his work also contains 
whatever his own measure of intelligence enabled 
him to find useful (qua juxta modicitatem mei in- 
genii utilia reputavi). Indeed it is the critical judg- 


ment displayed by Chauliac in selecting from his 
predecessors that best illustrates at once the prac 
tical character of his intellect and his discerning 
spirit. What the men of his time are said to have 
lacked is the critical faculty. They were encyclo 
pedic in intellect and gathered all kinds of informa 
tion without discrimination, is a very common criti 
cism of medieval writers. No one can say this of 
Chauliac, however, and, above all, he was no re 
specter of authority, merely for the sake of author 
ity. His criticism of John of Gaddesden s book 
shows that the blind following of those who had 
gone before was his special bete noir. His bitterest 
reproach for many of his predecessors was that 
" they follow one another like cranes, whether for 
love or fear, I cannot say." 

Chauliac s right to the title of father of surgery 
will perhaps be best appreciated from the brief ac 
count of his recommendations as to the value of sur 
gical intervention for conditions in the three most 
important cavities of the body, the skull, the thorax, 
and the abdomen. These cavities have usually been 
the dread of surgeons. Chauliac not only used the 
trephine, but laid down very exact indications for its 
application. Expectant treatment was to be the 
rule in wounds of the head, yet when necessary, in 
terference was counselled as of great value. His 
prognosis of brain injuries was much better than 
that of his predecessors. He says that he had seen 
injuries of the brain followed by some loss of brain 
substance, yet with complete recovery of the patient. 
In one case that he notes a considerable amount 
of brain substance was lost, yet the patient recovered 


with only a slight defect of memory, and even this 
disappeared after a time. He lays down exact indi 
cations for the opening of the thorax, that noli me 
tangere of surgeons at all times, even our own, and 
points out the relations of the ribs and the dia 
phragm, so as to show just where the opening should 
be made in order to remove fluid of any kind. 

In abdominal conditions, however, Chauliac s an 
ticipation of modern views is most surprising. He 
recognized that wounds of the intestines were surely 
fatal unless leakage could be prevented. Accord 
ingly he suggested the opening of the abdomen and 
the sewing up of such intestinal wounds as could be 
located. He describes a method of suture for these 
cases and seems, like many another abdominal sur 
geon, even to have invented a special needleholder. 

To most people it would seem absolutely out of the 
question that such surgical procedures could be prac 
tised in the fourteenth century. "We have the definite 
record of them, however, in a text-book that was the 
most read volume on the subject for several cen 
turies. Most of the surprise with regard to these 
operations will vanish when it is recalled that in 
Italy during the thirteenth century, as we have al 
ready seen, methods of anesthesia by means of 
opium and mandragora were in common use, having 
been invented in the twelfth century and perfected 
by Ugo da Lucca, and Chauliac must not only have 
known but must have frequently employed various 
methods of anaesthesia. 

In discussing amputations he has described in 
general certain methods of anaesthesia in use in his 
time, and especially the method by means of inhala- 


tion. It would not seem to us in the modern time 
that this method would be very successful, but there 
is an enthusiastic accord of authorities attesting that 
operations were done at this time with the help of 
this inhalant without the infliction of pain. Chauliac 

" Some prescribe medicaments which send the pa 
tient to sleep, so that the incision may not be felt, 
such as opium, the juice of the morel, hyoscyamus, 
mandrake, ivy, hemlock, lettuce. A new sponge is 
soaked by them in these juices and left to dry in the 
sun; and when they have need of it they put this 
sponge into warm water and then hold it under the 
nostrils of the patient until he goes to sleep. Then 
they perform the operation." 

Many people might be prone to think that the 
hospitals of Chauliac s time would not be suitable 
for such surgical work as he describes. It is, how 
ever, only another amusing assumption of this self- 
complacent age of ours to think that we were the 
first who ever made hospitals worthy of the name 
and of the great humanitarian purpose they sub 
serve. As a matter of fact, the old-time hospitals 
were even better than ours or, as a rule, better than 
any we had until the present generation. In " The 
Popes and Science," in the chapter on " The Foun 
dation of City Hospitals," I call attention to the 
fact that architects of the present day go back to 
the hospitals of the Middle Ages in order to find 
the models for hospitals for the modern times. Mr. 
Arthur Dillon, a well-known Xew York architect, 
writing of a hospital built at Tonnerre in France, to 
ward the end of the thirteenth century (1292), says: 


It was an admirable hospital in every way, and 
it is doubtful if we to-day surpass it. It was iso 
lated ; the ward was separated from the other build 
ings ; it had the advantage we so often lose of being 
but one story high, and more space was given to 
each patient than we can now afford. 

" The ventilation by the great windows and ven 
tilators in the ceiling was excellent ; it was cheerfully 
lighted ; and the arrangement of the gallery shielded 
the patients from dazzling light and from draughts 
from the windows and afforded an easy means of 
supervision, while the division by the roofless low 
partitions isolated the sick and obviated the depres 
sion that comes from sight of others in pain. 

" It was, moreover, in great contrast to the cheer 
less white wards of to-day. The vaulted ceiling was 
very beautiful; the woodwork was richly carved, 
and the great windows over the altars were filled 
with colored glass. Altogether it was one of the 
best examples of the best period of Gothic Archi 
tecture." 1 

The fine hospital thus described was but one of 
many. Virchow, in his article on hospitals quoted in 
the same chapter, called attention to the fact that in 
the thirteenth and fourteenth centuries every town 
of five thousand or more inhabitants had its hospital, 
founded on the model of the great Santo Spirito 
Hospital in Rome, and all of them did good work. 
The surgeons of Guy de Chauliac s time would in 
deed find hospitals wherever they might be called in 
consultation, even in small towns. They were more 
numerous in proportion to population than our own 

1 See picture of the hospital ward at Tonnerre, in " The Thirteenth 
Greatest of Centuries," 3rd edit., New York, 1911. 


and, as a rule, at least as well organized as ours 
were until the last few years. 

It is no wonder that with such a good hospital 
organization excellent surgery was accomplished. 
Hernia was Chauliac s specialty, and in it his sur 
gical judgment is admirable Mondeville before his 
time did not hesitate to say that many operations 
for hernia were done not for the benefit of the pa 
tient, but for the benefit of the surgeon, a very 
striking anticipation of remarks that one sometimes 
hears even at the present time. Chauliac discussed 
operations for hernia very conservatively. His rule 
was that a truss should be worn, and no operation 
attempted unless the patient s life was endangered 
by the hernia. It is to him that we owe the inven 
tion of a well-developed method of taxis, or manipu 
lation of a hernia, to bring about its reduction, which 
was in use until the end of the nineteenth century. 
He suggested that trusses could not be made accord 
ing to rule, but must be adapted to each individual 
case. He invented several forms of truss himself, 
and in general it may be said that his manipulative 
skill and his power to apply his mechanical prin 
ciples to his work are the most characteristic of his 
qualities. This is particularly noteworthy in his 
chapters on fractures and dislocations, in which he 
suggests various methods of reduction and realizes 
very practically the mechanical difficulties that were 
to be encountered in the correction of the deform 
ities due to these pathological conditions. In a word, 
we have a picture of the skilled surgeon of the mod 
ern time in this treatise of a fourteenth-century 
teacher of surgery. 


Chauliac discusses six different operations for the 
radical cure of hernia. As Gurlt points out, he 
criticises them from the same standpoint as that of 
recent surgeons. The object of radical operations 
for hernia is to produce a strong, firm tissue support 
over the ring through which the cord passes, so that 
the intestines cannot descend through it. It is 
rather interesting to find that the surgeons of this 
time tried to obliterate the canal by means of the 
cautery, or inflammation producing agents, arsenic 
and the like, a practice that recalls some methods 
still used more or less irregularly. They also used 
gold wire, which was to be left in the tissues and is 
supposed to protect and strengthen the closure of 
the ring. At this time all these operations for the 
radical cure of hernia involved the sacrifice of the 
testicle because the old surgeons wanted to obliterate 
the ring completely, and thought this the easiest 
way. Chauliac discusses the operation in this re 
spect and says that he has seen many cases hi which 
men possessed of but one testicle have procreated, 
and this is a case where the lesser of two evils is to 
be chosen. 

Of course Guy de Chauliac would not have been 
able to operate so freely on hernia and suggest, fol 
lowing his own experience, methods of treatment of 
penetrating wounds of the abdomen only that he had 
learned the lessons of antiseptic surgery which had 
been gradually developed among the great surgeons 
of Italy during the preceding century. The use of 
the stronger wines as a dressing together with in 
sistence on the most absolute cleanliness of the sur 
geon before the operation, and careful details of 


cleanliness during the operation, made possible the 
performance of many methods of surgical interven 
tion that would otherwise surely have been fatal. 
Probably nothing is harder to understand than that 
after these practical discoveries men should have 
lost sight of their significance, and after having 
carefully studied the viscous exudation which pro 
duces healthy natural union, should have come to the 
thought of the necessity for the formation of laud 
able pus before union might be expected. The mys 
tery is really no greater than that of many another 
similar incident in human history, but it strikes us 
more forcibly because the discovery and gradual de 
velopment of antiseptic surgery in our own time has 
meant so much for us. Already even in Chauliac s 
practice, however, some of the finer elements of the 
technique that made surgery antiseptic to a marked 
degree, if not positively aseptic in many cases, were 
not being emphasized as they were by his predeces 
sors, and there was a beginning of surgical meddle 
someness reasserting itself. 

It must not be thought, however, that it was only 
with the coarse applications of surgery that Chau- 
liac concerned himself. He was very much inter 
ested in the surgical treatment of eye diseases and 
wrote a monograph on cataract, in which he gathers 
what was known before his time and discusses it in 
the light of his own experience. The writing of 
such a book is not so surprising at this time if we 
recall that in the preceding century the famous Pope 
John XXI, who had been a physician before he be 
came Pope, and under the name of Peter of Spain 
was looked up to as one of the distinguished sci- 


enlists of his time, had written a book on eye dis 
eases that has recently heen the subject of much 

Pope John had much to say of cataract, dividing 
it into traumatic and spontaneous, and suggesting 
the needling of cataract, a gold needle being used 
for the purpose. Chauliac s method of treating 
cataract was by depression. His care in the selec 
tion of patients may be appreciated from his treat 
ment of John of Luxembourg, King of Bavaria, 
blind from cataract, who consulted Chauliac in 1336 
while on a visit to Avignon with the King of France. 
Chauliac refused to operate, however, and put off 
the King with dietary regulations. 

In the chapter on John of Arcoli and Medieval 
Dentistry we call attention to the fact that Chauliac 
discussed dental surgery briefly, yet with such prac 
tical detail as to show very clearly how much more 
was known about this specialty in his time than we 
have had any idea of until recent years. He recog 
nized the dentists as specialists, calls them denta- 
tores, but thinks that they should operate under the 
direction of a physician hence the physician should 
know much about teeth and especially about their 
preservation. He enumerates instruments that 
dentists should have and shows very clearly that the 
specialty had reached a high state of development. 
A typical example of Chauliac s common sense and 
dependence on observation and not tradition is to 
be found in what he has to say with regard to 
methods of removing the teeth without the use of 
extracting instruments. It is characteristic of his 
method of dealing with traditional remedies, even 


though of long standing, that he brushes them aside 
with some impatience if they have not proved them 
selves in his experience. 

" The ancients mention many medicaments, which 
draw out the teeth without iron instruments or which 
make them more easy to draw out ; such as the milky 
juice of the tithymal with pyrethrum, the roots of 
the mulberry and caper, citrine arsenic, aqua fortis, 
the fat of forest frogs. But these remedies promise 
much and accomplish but little mais Us donnent 
beaucoup de prowesses, et peu d operations." 

It is no wonder that Chauliac has been enthusi 
astically praised. Nicaise has devoutly gathered 
many of these praises into a sheaf of eulogies at the 
end of his biography of the great French surgeon. 
He tells us that Fallopius compared him to Hippoc 
rates. John Calvo of Valencia, who translated the 
" Great Surgery into Spanish, looks upon him 
as the first law-giver of surgery. Freind, the great 
English physician, in 1725 called him the Prince 
of Surgeons. Ackermann said that Guy de Chau- 
liac s text-book will take the place of all that has 
been written on the subject down to his time, so that 
even if all the other works had been lost his would 
replace them. Dezimeris, commenting on this, says 
that " if one should take this appreciation literally, 
this surgeon of the fourteenth century would be the 
first and, up to the present time, the only author 
who ever merited such an eulogy." " At least," he 
adds, we cannot refuse him the distinction of hav 
ing made a work infinitely superior to all those which 
appeared up to this time and even for a long time 
afterwards. Posterity rendered him this justice, for 


he was for three centuries the classic par excellence. 
He rendered the study easy and profitable, and all 
the foreign nations the tributaries of our country." 
Peyrihle considered Guy s " Surgery " as the most 
valuable and complete work of all those of the same 
kind that had been published since Hippocrates and 
added that the reading of it was still useful in his 
time in 1784. Begin, in his work on Ambroise Pare, 
says " that Guy has written an immortal book to 
which are attached the destinies of French surgeons." 
Malgaigne, in his " History of Surgery," does not 
hesitate to say, " I do not fear to say that, Hip 
pocrates alone excepted, there is not a single treatise 
on surgery, Greek, Latin, or Arabic, which I 
place above, or even on the same level with, this 
magnificent work, The Surgery of Guy de Chau- 
liac. " Daremberg said, " Guy seems to us a sur 
geon above all erudite, yet expert and without ever 
being rash. He knows, above all, how to choose 
what is best in everything. Verneuil, in his " Con 
ference sur Les Chirurgiens Erudits," says, " The 
services rendered by the Great Surgery were im 
mense; by it there commenced for France an era 
of splendor. It is with justice, then, that posterity 
has decreed to Guy de Chauliac the title of Father 
of French surgery." 

The more one reads of Chauliac s work the less 
is one surprised at the estimation in which he has 
been held wherever known. It would not be hard 
to add a further sheaf of compliments to those col 
lected by Nicaise. Modern writers on the history 
of medicine have all been enthusiastic in their ad 
miration of him, just in proportion to the thorough- 


ness of their acquaintance with him. Portal, in his 
" History of Anatomy and Surgery," says, 
" Finally, it may be averred that Guy de Chauliac 
said nearly everything which modern surgeons say, 
and that his work is of infinite price but unfortu 
nately too little read, too little pondered." Mal- 
gaigne declares Chauliac s " Chirurgia Magna " to 
be " a masterpiece of learned and luminous writ 
ing." Professor Clifford Allbutt, the Eegius Pro 
fessor of Physic at the University of Cambridge, 
says of Chauliac s treatise: " This great work I 
have studied carefully and not without prejudice; 
yet I cannot wonder that Fallopius compared the 
author to Hippocrates or that John Freind calls 
him the Prince of Surgeons. It is rich, aphoristic, 
orderly, and precise." * 

If to this account of his professional career it be 
added that Chauliac s personality is, if possible, 
more interesting than his surgical accomplishment, 
some idea of the significance of the life of the great 
father of modern surgery will be realized. "We have 
already quoted the distinguished words of praise 
accorded him by Pope Clement VI. That they were 
well deserved, Chauliac s conduct during the black 
death which ravaged Avignon in 1348, shortly after 
his arrival in the Papal City, would have been suffi 
cient, of itself to attest. The occurrence of the 
plague in a city usually gave rise to an exhibition 
of the most arrant cowardice, and all who could, 
fled. In many of the European cities the physicians 
joined the fugitives, and the ailing were left to care 

"The Historical Relations of Medicine and Surgery," by T. Clifford 
Allbutt, M.A., M.D. London: Macmillan & Co., Ltd., 1905. 


for themselves. With a few notable exceptions, this 
was the case at Avignon, but Guy was among those 
who remained faithful to his duty and took on him 
self the self-sacrificing labor of caring for the sick, 
doubly harassing because so many of his brother 
physicians were absent. He denounces their con 
duct as shameful, yet does not boast of his own 
courage, but on the contrary says that he was in 
constant fear of the disease. Toward the end of 
the epidemic he was attacked by the plague and 
for a time his life was despaired of. Fortunately 
he recovered, to become the most influential among 
his colleagues, the most highly admired of the physi 
cians of his generation, and the close personal friend 
of all the high ecclesiastics, who had witnessed his 
magnificent display of courage and of helpfulness 
for the plague-stricken during the epidemic. He 
wrote a very clear account of the epidemic, 
which leaves no doubt that it was true bubonic 

After this fine example, Chauliac s advice to 
brother physicians in the specialty of surgery car 
ried added weight. In the Introductory chapter of 
his Chirurgia Magna he said : 

< . 

The surgeon should be learned, skilled, in 
genious, and of good morals. Be bold in things that 
are sure, cautious in dangers; avoid evil cures and 
practices; be gracious to the sick, obliging to his 
colleagues, wise in his predictions. Be chaste, sober, 
pitiful, and merciful; not covetous nor extortionate 
of money; but let the recompense be moderate, ac 
cording to the work, the means of the sick, the char 
acter of the issue or event, and its dignity." 


No wonder that Malgaigne says of him, " Never 
since Hippocrates has medicine heard such language 
filled with so much nobility and so full of matter 
in so few words." 

Chauliac was in every way worthy of his great 
contemporaries and the period in which his lot was 
cast. Ordinarily we are not apt to think of the 
early fourteenth century as an especially productive 
period in human history, but such it is. Dante s 
Divine Comedy was entirely written during Chau 
liac s life. Petrarch was born within a few years 
of Chauliac himself; Boccaccio in Italy, and Chaucer 
in England, wrote while Chauliac was still alive. 
Giotto did his great painting, and his pupils were 
laying the deep, firm foundations of modern art. 
Many of the great cathedrals were being finished. 
Most of the universities were in the first flush of 
their success as moulders of the human mind. There 
are few centuries in history that can show the exist 
ence of so many men whose work was to have an 
enduring influence for all the after time as this 
upon which Chauliac s career shed so bright a light. 
The preceding century had seen the origin of the 
universities and the rise of such supremely great 
men as Albertus Magnus, Eoger Bacon, Thomas 
Aquinas, and the other famous scholars of the early 
days of the mendicant orders, and had made the in 
tellectual mould of university training in which 
men s minds for seven centuries were to be formed, 
so that Chauliac, instead of being an unusual phe 
nomenon is only a fitting expression of the interest 
of this time in everything, including the physical 
sciences and, above all, medicine and surgery. 


For some people it may be a source of surprise 
that Chauliac should have had the intellectual train 
ing to enable him to accomplish such judicious work 
in his specialty. Many people will be apt to assume 
that he accomplished what he did in spite of his 
training, genius succeeding even in an unfavorable 
environment, and notwithstanding educational dis 
advantages. Those who would be satisfied with any 
such explanation, however, know nothing of the edu 
cational opportunities provided in the period of 
which Chauliac was the fruit. He is a typical uni 
versity man of the beginning Otf the fourteenth cen 
tury, and the universities must be given due credit 
for him. It is ordinarily assumed that the univer 
sities paid very little attention to science and that 
scientists would find practically nothing to satisfy 
in their curricula. Professor Huxley in his address 
on " Universities, Actual and Ideal," delivered as 
the Kectorial Address at Aberdeen University in 
1874, declared that they were probably educating in 
the real sense of the word better than we do now. 
(See quotation in " The Medical School at 

In the light of Chauliac s life it is indeed amusing 
to read the excursions of certain historians into the 
relationship of the Popes and the Church to science 
during the Middle Ages. Chauliac is typically rep 
resentative of medieval science, a man who gave due 
weight to authority, yet tried everything by his 
own experience, and who sums up in himself such 
wonderful advance in surgery that during the last 
twenty years the students of the history of medicine 


have been more interested in him than in anyone 
who comes during the intervening six centuries. 
Chauliac, however, instead of meeting with any op 
position, encountered encouragement, liberal patron 
age, generous interest, and even enjoj^ed the inti 
mate friendship of the highest ecclesiastics and the 
Popes of his tune. In every way his life may be 
taken as a type of what we have come to know about 
the Middle Ages, when we know them as we should, 
in the lives of the men who counted for most in 
them, and do not accept merely the broad general 
izations which are always likely to be deceptive and 
which in the past have led men into the most absurd 
and ridiculous notions with regard to a wonderful 
period in human history. 

That Guy de Chauliac was no narrow specialist 
is abundantly evident from his book, for while the 
" Great Surgery " treats of the science and art of 
surgery as its principal subject, there are remarks 
about nearly everything else relating to medicine, 
and most of them show a deep interest, a thorough 
familiarity, and an excellent judgment. Besides we 
have certain expressions with regard to intellectual 
matters generally which serve to show Guy as a pro 
found thinker, who thoroughly appreciated just how 
accumulations of knowledge came to men and how 
far each generation or member of a generation 
should go and yet how limited must, after all, be 
the knowledge obtained by any one person. "With 
regard to books, for instance, he said, " for every 
one cannot have all the books, and even if he did 
have them it would be too tiresome to read them all 


and completely, and it would require a godlike 
memory to retain them all." He realized, however, 
that each generation, provided it took the oppor 
tunities offered it, was able to see a little bit farther 
than its predecessor, and the figure that he employs 
to express this is rather striking. " Sciences," he 
said, " are made by additions. It is quite impossible 
that the man who begins a science should finish it. 
We are like infants, clinging to the neck of a giant; 
for we can see all the giant sees and a little more." 

One of the most interesting features of the history 
of Guy de Chauliac is the bibliography of his works 
which has been written by Nicaise. This is ad 
mirably complete, labored over with the devotion 
that characterized Nicaise s attitude of unstinted 
admiration for the subject. Altogether he has some 
sixty pages of a quarto volume with regard to the 
various editions of Guy s works. 

The first manuscript edition of Guy de Chauliac 
was issued in 1363, the first printed edition in 1478. 
Even in the fourteenth century Guy s great work 
was translated into all the languages generally used 
in Europe. Nicaise succeeded in placing 34 com 
plete manuscripts of the " Great Surgery ": 22 of 
these are in Latin, 4 are in French, 3 are in English, 
2 only in Provencal, though that was the language 
spoken in the region where much of Chauliac s life 
was passed, and one each in Italian, in Low Dutch, 
and in Hebrew. Of the English manuscripts, one is 
number twenty-five English of the Bibliotheque 
Nationale, Paris; a second is number 3666 English 
of the Sloane collection in the British Museum, and 


a third is in the Library of the University of Cam 
bridge. 1 

Paulin Paris, probably one of the best of recent 
authorities on the age and significance of old manu 
scripts, says in the third volume of his Manuscrits 
Frangais," page 346, " This manuscript [of Guy 
de Chauliac s " Great Surgery "] was made, if not 
during the life, then certainly very shortly after the 
death of the author. It is one of the oldest that can 
be cited, and the fact that an English translation 
was made so near to the time of the original com 
position of the book attests the great reputation 
enjoyed by Guy de Chauliac at this time, and which 
posterity has fully confirmed." 

The Sloane copy in the British Museum contains 

1 The beginning of the manuscript copy in the "Bibliotheque Natio- 
nale " is extremely interesting as an example of the English of the period, 
and alongside of it it seems worth while to quote the closing sentence 
as Nicaise reproduces them : 

"In godes name here bygyneth the inventarie of gadryng to gedre 
medecyne in the partye of cyruvgie compilede and fulfilled in the zere 
(yere?) of our Loord 1363 by Guide de Cauliaco cirurgene and doctor 
of physik in the f ulclere studye of Mountpylerz. 

" On page 191, verso. Here endeth the cyrurgie of Maistre Guyd de 
Cauliaco dottoure of phisik." 

The University of Cambridge copy has the title in the colophon. It 
runs as follows: "Ye inventorye of Guydo de Caulhiaco Doctor of 
Phisyk and Cirurgien in Ye Universitie of Mount Pessulanee of Mont- 
peleres." The fly-leaf contains the words, " Jesu Christ save ye soule 
of mien. It is rather interesting to note how much closer to modern 
English is this copy, made probably not much more than half a century 
later than the first one and, above all, how much more nearly the spell 
ing has come. At this time, however, and, indeed, for more than a 
century later, spelling had no fixed rule, and a man might spell the 
same word quite differently even on the same page. The difference 
between doctor spelled thus in the early edition, and doctours in the 
later one, probably means nothing more than personal peculiarities of 
the original translator or copyist. 


some medical recipes at the end by Francis Verney. 
It was probably written in the fifteenth century. 
Its title is : 

" The inventorie or the collectorie in cirurgicale 
parte of medicine compiled and complete in the yere 
of our Lord 1363, with some additions of other doc- 
tours, necessary to the foresaid arte or crapte 
(crafte?)." 1 

What we find in the period of manuscripts, how 
ever, is as nothing compared to the prestige of Guy 
de Chauliac s work, once the age of printing began. 
Nicaise was able to find sixty different printed edi 
tions of the " Great Surgery." Nine others that are 
mentioned by authors have disappeared and ap 
parently no copies of them are in existence. Besides 
there are sixty editions of portions of the work, of 
compendiums of it and commentaries on it. Alto 
gether 129 editions are extant. Of these there are 
sixteen Latin editions, forty-three French, five 
Italian, four Low Dutch, five Catalan, and one Eng 
lish. Fourteen appeared in the fifteenth century, 
thirty-eight in the sixteenth century, and seventeen 
in the seventeenth century. The fourteen editions 
belonging to the incunabula of printing, issued, that 
is, before the end of the fifteenth century, show what 
lively interest there was in the French surgeon of 
the preceding century, since printing presses at this 
precious time were occupied only with the books that 

1 In Nicaise this last word is written crapte. I have ventured to 
suggest crafte, since a misreading between the two letters would be 
so easy. In the same way I have suggested tentatively a changing 
of the z in the title of the Bibliotbeque Nationale copy to y, mak 
ing the word yere instead of zere. 


were considered indispensable for scholars. The 
first edition of the " Great Surgery " was printed in 
1478 at Lyons. Printing had only been introduced 
there five years before. This first edition, primus 
primarius or editio princeps, was a French transla 
tion by Nicholas Panis. In 1480 an Italian edition 
was printed at Venice. The first Latin edition was 
printed also in Venice in 1490. 

It would be only natural to expect that the suc 
cessors of Guy de Chauliac, and especially those who 
had come personally in contact with him, would take 
advantage of his thorough work to make still fur 
ther advances in surgery. As matter of fact, de 
cadence in surgery is noted immediately after his 
death. Three men taught at the University of 
Montpellier at the end of the fourteenth and the be 
ginning of the fifteenth century, John de Tornamira, 
Valesco de Taranta, and John Faucon. They can 
not be compared, Gurlt says, with Guy de Chauliac, 
though they were physicians of reputation in their 
time. Faucon made a compendium of Guy s work 
for students. Somehow there seemed to be the im 
pression that surgery had now reached a point of 
development beyond which it could not advance. 
Unfortunate political conditions, wars, the with 
drawal of the Popes from Avignon to Eome, and 
other disturbances, distracted men s minds, and 
surgery deteriorated to a considerable extent, until 
the new spirit at the time of the Renaissance came 
to inject fresh life into it. 




If there is one phase of our present-day medicine 
and surgery that most of us are likely to be quite 
sure is of very recent development it is dentistry. 
Probably most people would declare at once that 
they had every reason to think that the science and 
art of dentistry, as we have it now, developed for 
the first time in the world s history during the last 
generation or two. It is extremely interesting to 
realize then, in the light of this almost universal 
persuasion, founded to a great extent on the con 
viction that man is in process of evolution and that 
as a consequence we must surely be doing things 
now that men never did before, to find that dentistry, 
both as an art and science, is old; that it has devel 
oped at a number of times in the world s history, 
and that as fortunately for history its work was 
done mainly in indestructible materials, the teeth 
themselves and metal prosthetic apparatus, we have 
actual specimens of what was accomplished at a num 
ber of periods in the olden times. Surprising as it 
will seem to those who hear of it for the first time, 
dentistry reached high perfection even in what we 
know as ancient history. It is rather easy to trace 
scientific and craftsmanlike interest in it during the 



medieval period and in the magnificent development 
of surgery that came just at the end of the Middle 
Ages, dentistry shared to such degree that some of 
the text -books of the writers on surgery of this time 
furnish abundant evidence of anticipations of many 
of the supposedly most modern developments of den 

There are a number of historical traditions with 
regard to dentistry and the treatment of the teeth in 
Egypt that can be traced back to good authorities 
in Egyptology of a generation or more ago, but it is 
rather hard to confirm the accounts we have by 
actual specimens; either none were found or for 
some reason those actually discovered are now not 
readily available for study. Among the Phenicians 
however, though we have good reasons to think that 
they learned their arts and crafts from the Egyp 
tians, there is convincing evidence of a high develop 
ment of dentistry. M. Ernest Renan, during an ex 
ploring expedition in Phenicia, found in the old 
necropolis at Sidon a set of teeth wired together, two 
of which were artificial. It was a striking example 
of bridgework, very well done, and may now be seen 
in the Louvre. It would be more than a little surpris 
ing, from what we know of the lack of inventiveness 
on the part of the Phenicians and their tendency 
to acquire their arts by imitation, if they had reached 
such a climax of invention by themselves. Since 
they adapted and adopted most of their arts and 
crafts from Egypt, with which they were in close 
commercial relations, it has been argued with some 
plausibility that the Egyptians may have had many 
modes of dental prosthesis, but removed all artificial 


teeth and dental appliances from the rnouth of 
corpses before embalming them, in preparation for 
the next world, because there was some reli 
gious objection to such human handiwork being 
left in place for the hereafter, as they hoped 
for it. 

There is a well-authenticated tradition of intimate 
intercourse in a commercial way between the old 
Etruscans who inhabited the Italian hill country and 
the Phenicians, so that it is no surprise to find that 
the oldest of Etruscan tombs contain some fine ex 
amples of bridge work. An improvement has come 
over Phenician work however, and bands of gold 
instead of wire are used for holding artificial teeth 
in place. Guerini, whose " History of Dentistry " 
is the standard work on the subject, on a commission 
from the Italian government, carefully studied these 
specimens of Etruscan dental work in the museums 
of Italy, and has made some interesting observa 
tions on them. In one specimen, which is espe 
cially notable, two incisor teeth are replaced by a 
single tooth from a calf. This was grooved in such 
a way as to make it seem like two separate teeth. 
Guerini suggests a very interesting and quite unex 
pected source for this. While examining the speci 
men he wondered where the old Etruscan dentist 
had obtained a calf s tooth without a trace of wear 
on it. He came to the conclusion that he must have 
cut into the gums of a young calf before the per 
manent tooth was erupted in order to get this struc 
ture absolutely unworn for his purpose. A number 
of examples of bridgework have been found in the 
old Etruscan tombs. The dates of their construe- 


tion are probably not later than 500 B.C., and some 
of them are perhaps earlier than 700 B.C. 

The Etruscans affected the old Romans in the mat 
ter of dentistry, so that it is easy to understand the 
passage in the " Laws of the Twelve Tables," issued 
about 450 B.C., which, while forbidding the burial of 
gold with corpses, made a special exception for such 
gold as was fastened to the teeth. Gold was rare 
at Rome, and care was exercised not to allow any 
unnecessary decrease of the visible supply almost in 
the same way as governments now protect their gold 
reserves. It may seem like comparing little things 
with great, but the underlying principle is the same. 
Hence this special law and its quite natural excep 

In Pope Julius Museum in Rome there is a speci 
men of a gold cap made of two plates of gold riveted 
together and also riveted to bands of metal which 
were fastened around the neighboring teeth in order 
to hold the cap in place. This is from later Repub 
lican times at Rome. At the end of the Republic 
and the beginning of the Empire there appear to 
have been many forms of dental appliances. Martial 
says that the reason \vhy one lady s teeth whose 
name he does not conceal are white and another s 
name also given were dark, was that the first 
one bought hers and the second still had her 
own. In another satiric poem he describes an elderly 
woman as so much frightened that when she ran 
away her teeth fell out, while her friends lost their 
false hair. Fillings of many kinds were used, den- 
trifices of nearly every kind were invented, and den 
tistry evidently reached a high stage of development, 


though we have nowhere a special name for dentist, 
and the work seems to have been done by physicians, 
who took this as a specialty. 

While in the Middle Ages there was, owing to con 
ditions, a loss of much of this knowledge of antiquity 
with regard to dentistry, or an obscuration of it, it 
never disappeared completely, and whenever men 
have written seriously about medicine, above all 
about surgery in relation to the face and the mouth, 
the teeth have come in for their share of scientific 
and practical consideration. Aetius, the first impor 
tant Christian writer on medicine and surgery, dis 
cusses, as we have seen in the sketch of him, the 
nutrition of the teeth, their nerves, " which came 
from the third pair and entered the teeth by a small 
hole existing at the end of the root," and other in 
teresting details of anatomy and physiology. He 
knows much about the hygiene of the teeth, discusses 
extraction and the cure of fistula and other details. 
Paul of ^gina in the next century has much more, 
and while they both quote mainly from older authors 
there seems no doubt that they themselves had made 
not a few observations and had practical experience. 

It was from these men that the Arabian physicians 
and surgeons obtained their traditions of medicine, 
and so it is not surprising to find that they discuss 
dental diseases and their treatment rationally and 
in considerable detail. Abulcasis particularly has 
much that is of significance and interest. We have 
pictures of two score of dental instruments that were 
used by them. The Arabs not only treated and filled 
carious teeth and even replaced those that were 
lost, but they also corrected deformities of the mouth 


and of the dental arches. Orthodontia is sometimes 
said to be of much later origin and to begin many 
centuries after Abulcasis time, yet no one who 
knows of his vrork can speak of Orthodontia as an 
invention after him. In this, however, as in most of 
the departments of medicine and surgery, the Arabs 
were merely imitators, though probably they ex 
panded somewhat the practical knowledge that had 
come to them. 

When the great revival in surgery came in the 
twelfth and thirteenth centuries it is not surprising 
that there should also have been an important re 
newal of interest in dentistry. A detailed review 
of this would take us too far afield, but at least 
something may be said of two or three of the great 
representative surgical writers who touched on this 

About the middle of the fourteenth century that 
prince of surgeons, and model of surgical writers. 
Guy de Chauliac, wrote his great text-book of sur 
gery, " Le Grande Chirurgie." An extremely inter 
esting feature of this work is to be found in the 
chapters that treat of diseases of the teeth. These 
are not very comprehensive, and are evidently not 
so much the result of his experience, as the fruit 
of his reading, yet they contain many practical valua 
ble ideas that are supposed to be ever so much 
later than the middle of the fourteenth century. 
His anatomy and physiology at least are not without 
many errors. His rules for the preservation of the 
teeth show that the ordinary causes of dental decay 
were well recognized even as early as this. Emphasis 
was laid on not taking foods too hot or too cold, and 


above all not to follow either hot or cold food by 
something very different from it in temperature. 
The breaking of hard things with the teeth was 
recognized as one of the most frequent causes of 
such deterioration of the enamel as gives oppor 
tunity for the development of decay. The eating 
of sweets, and especially the sticky sweets pre 
serves and the like was recognized as an important 
source of caries. The teeth were supposed to be 
cleaned frequently, and not to be cleaned too roughly, 
for this would do more harm than good. We find 
these rules repeated by succeeding writers on gen 
eral surgery, who touch upon dentistry, or at least 
the care of the teeth, and they were not original 
with Guy de Chauliac, but part of the tradition of 

As noted by Guerini in his " History of Den 
tistry," the translation of which was published under 
the auspices of the National Dental Association of 
the United States of America, 1 Chauliac recognized 
the dentists as specialists. Besides, it should be 
added, as is evident from his enumeration of the sur 
gical instruments which he declares necessary for 
them, they were not as we might easily think in the 
modern time mere tooth pullers, but at least the best 
among them treated teeth as far as their limited 
knowledge and means at command enabled them to 
do so, and these means were much more elaborate 
than we have been led to think, and much more de- 

1(1 A History of Dentistry from the Most Ancient Times Until the 
End of the Eighteenth Century," by Dr. Vincenzo Guerini, editor of the 
Italian Review L Odonto-Stomatoloyia, Philadelphia and New York, Lea 
and Febriger, 1909. 


tailed than we have reason to know that they were at 
certain subsequent periods. 

In fact, though Guy de Chauliac frankly confesses 
that he touches on the subject of dentistry only in 
order to complete his presentation of the subject of 
surgery and not because he has anything of his own 
to say with regard to the subject, there is much that 
is of present-day interest in his brief paragraphs. 
He observes that operations on the teeth are special 
and belong to the dentatores, or dentists, to whom 
doctors had given them over. He considers, how 
ever, that the operations in the mouth should be per 
formed under the direction of a physician. It is in 
order to give physicians the general principles with 
which they may be able to judge of the advisability 
or necessity for dental operations that his short 
chapters are written. If their advice is to be of 
value, physicians should know the various methods 
of treatment suitable for dental diseases, including 
mouth washes, gargles, masticatories, anointments, 
rubbings, fumigations, cauterizations, fillings, filings, 
and the various manual operations. He says that 
the dentator must be provided with the appropriate 
instruments, among which he names scrapers, rasps, 
straight and curved spatumina, elevators, simple and 
with two branches, toothed tenacula, and many dif 
ferent forms of probes and canulas. He should also 
have small scalpels, tooth trephines, and files. 

Chauliac is particularly emphatic in his insistence 
on not permitting alimentary materials to remain 
in cavities, and suggests that if cavities between 
the teeth tend to retain food material they should 
even be filed in such a way as to prevent these 


accumulations. His directions for cleansing the 
teeth were rather detailed. His favorite treatment 
for wounds was wine, and he knew that he suc 
ceeded by means of it in securing union by first 
intention. It is not surprising, then, to find that he 
recommends rinsing of the mouth with wine as a 
precaution against dental decay. A vinous decoction 
of wild mint and of pepper he considered particularly 
beneficial, though he thought that dentifrices, either 
powder or liquid, should also be used. He seems 
to recommend the powder dentifrices as more effica 
cious. His favorite prescription for a tooth powder, 
while more elaborate, resembles to such an extent, 
at least some, if not indeed most of those, that 
are used at the present time, that it seems worth 
while giving his directions for it. He took equal 
parts of cuttle bone, small white sea-shells, pumice 
stone, burnt stag s horn, nitre, alum, rock salt, burnt 
roots of iris, aristolochia, and reeds. All of these 
substances should be carefully reduced to powder 
and then mixed. His favorite liquid dentifrice con 
tained the following ingredients, half a pound each 
of sal ammoniac and rock salt, and a quarter of a 
pound of sacharin alum. All these were to be re 
duced to powder and placed in a glass alembic and 
dissolved. The teeth should be rubbed with it, using 
a little scarlet cloth for the purpose. Just why this 
particular color of cleansing cloth was recommended 
is not quite clear. 

He recognized, however, that cleansing of the teeth 
properly often became impossible by any scrubbing 
method, no matter what the dentifrice used, because 
of the presence of what we call tartar and what he 


called hardened limosity or limyness (limosite en- 
durcie). When that condition is present he suggests 
the use of rasps and spatumina and other instru 
mental means of removing the tartar. 

Evidently he did not believe in the removal of 
the teeth unless this was absolutely necessary and 
no other method of treatment would avail to save 
the patient from continuous distress. He summar 
izes the authorities with regard to the extraction of 
teeth and the removal of dental fragments and roots. 
He evidently knew of the many methods suggested 
before his time of removing teeth without recourse 
to instrumental extraction. There were a number 
of applications to the gums that were claimed by 
older authors to remove the teeth without the need 
of metal instruments. "We might expect that Chau- 
liac would detect the fallacy with regard to these 
and expose it. He says that while much is claimed 
for these methods he has never seen them work in 
practice and he distrusts them entirely. 

The most interesting phase of what Guy de Chau- 
liac has to say with regard to dentistry is of course 
to be found in his paragraphs on the artificial re 
placement of lost teeth and the subject of dental 
prosthesis generally. When teeth become loose he 
advises that they be fastened to the healthy ones 
with a gold chain. Guerini suggests that he evi 
dently means a gold wire. If the teeth fall out they 
may be replaced by the teeth of another person or 
with artificial teeth made from oxbone, which may 
be fixed in place by a fine metal ligature. He says 
that such teeth may be serviceable for a long while. 
This is a rather curt way of treating so large a 


subject as dental prosthesis, but it contains a lot of 
suggestive material. He was quoting mainly the 
Arabian authors, and especially Abulcasis and Ali 
Abbas and Rhazes, and these of course, as we have 
said, mentioned many methods of artificially replac 
ing teeth as also of transplantation and of treat 
ment of the deformities of the dental arches. 

On the whole, however, it must be confessed that 
we have here in the middle of the fourteenth century 
a rather surprising anticipation of the knowledge of 
a special department of medicine which is usually 
considered to be distinctly modern, and indeed as 
having only attracted attention seriously in com 
paratively recent times. 

After Guy de Chauliac the next important con 
tributor to dentistry is Giovanni of Arcoli, often 
better known by his Latin name, Johannes Arcu- 
lanus, who was a professor of medicine and surgery 
at Bologna and afterwards at Padua, just before 
and after the middle of the fifteenth century, and 
who died in 1484. He is famous principally for be 
ing the first we know who mentions the filling of 
teeth with gold. 

It might possibly be suggested that coming at this 
time Arculanus should rather be reckoned as a Maker 
of Medicine in the Renaissance than as belonging to 
the Middle Ages and its influences. His education, 
however, was entirely completed before the earliest 
date at which the Renaissance movement is usually 
said to begin, that is with the fall of Constantinople 
in 1452, and he was dead before the other date, that 
of the discovery of America in 1492, which the 
Germans have in recent years come to set down as 


the end of the Middle Ages. Besides, what he has 
to say about dentistry occurs in typical medieval 
form. It is found in a commentary on Khazes, 
written just about the middle of the fifteenth cen 
tury. In the later true Kenaissance such a com 
mentary would have been on a Greek author. In his 
commentary Arculanus touches on most of the 
features of medicine and surgery from the stand 
point of his own experience as well as from what 
he knows of the writings of his predecessors and 
contemporaries. With the rest he has a series of 
chapters on diseases of the teeth. Guerini in his 
" History of Dentistry " says that " this subject 
[dentistry] is treated rather fully, and with great 
accuracy." Even some short references to it will, 
I think, demonstrate this rather readily. 1 

Arculanus is particularly full in his directions 
for the preservation of the teeth. We are rather 
prone to think that prophylaxis is comparatively a 
modern idea, and that most of the principles of 
conservation of human tissues and the prevention 
of deterioration and disease are distinctly modern. 
It needs only a little consideration of Arculanus in 
struction in the matter of the teeth, however, to 
undo any such false impression. For obvious 
reasons I prefer to quote Guerini s summation of 
this medieval student of dentistry s rules for dental 
hygiene : 

" For the preservation of teeth considered by 
him, quite rightly, a matter of great importance 

The first printed edition of Arculanue is that of Venice, 1542, 
bearing the Latin title, " Joannis Arculani Commentaria in Nonura 
Librum Rasis," etc. 


Giovanni of Arcoli repeats the various counsels 
given on the subject by preceding writers, but he 
gives them as ten distinct canons or rules, creating 
in this way a kind of decalogue of dental hygiene. 
These rules are : (1) It is necessary to guard against 
the corruption of food and drink within the stom 
ach; therefore, easily corruptible food milk, salt 
fish, etc. must not be partaken of, and after meals 
all excessive movement, running exercises, bathing, 
coitus, and other causes that impair the digestion, 
must also be avoided. (2) Everything must be 
avoided that may provoke vomiting. (3) Sweet and 
viscous food such as dried figs, preserves made 
with honey, etc. must not be partaken of. (4) Hard 
things must not be broken with the teeth. (5) All 
food, drink, and other substances that set the teeth 
on edge must be avoided. (6) Food that is too hot 
or too cold must be avoided, and especially the rapid 
succession of hot and cold, and vice versa. (7) Leeks 
must not be eaten, as such a food, by its own nature, 
is injurious to the teeth. (8) The teeth must be 
cleaned at once, after every meal, from the particles 
of food left in them ; and for this purpose thin pieces 
of wood should be used, somewhat broad at the ends, 
but not sharp-pointed or edged; and preference 
should be given to small cypress twigs, to the 
wood of aloes, or pine, rosemary, or juniper and 
similar sorts of wood which are rather bitter and 
styptic; care must, however, be taken not to search 
too long in the dental interstices and not to injure the 
gums or shake the teeth. (9) After this it is neces 
sary to rinse the mouth by using by preference a 
vinous decoction of sage, or one of cinnamon, 
mastich, gallia, moschata, cubeb, juniper seeds, root 
of cyperus, and rosemary leaves. (10) The teeth 
must be rubbed with suitable dentrifices before going 
to bed, or else in the morning before breakfast. Al 
though Avicenna recommended various oils for this 


purpose, Giovanni of ArcoK appears very hostile to 
oleaginous frictions, because he considers them very 
injurious to the stomach. He observes, besides, that 
whilst moderate frictions of brief duration are help 
ful to the teeth, strengthen the gums, prevent the 
formation of tartar, and sweeten the breath, too 
rough or too prolonged rubbing is, on the contrary, 
harmful to the teeth, and makes them liable to many 

All this is so modern in many ways that we might 
expect a detailed exact knowledge of the anatomy 
of the teeth and even something of their embryology 
from Arculanus. It must not be forgotten, however, 
that coming as he does before the Renaissance, the 
medical sciences in the true sense of the word are 
as yet unborn. Men are accumulating information 
for practical purposes but not for the classification 
and co-ordination that was to make possible the 
scientific development of their knowledge. 

Giovanni of Arcoli s acquaintance with the anat 
omy of the teeth was rather sadly lacking. He does 
not know even with certainty the number of roots 
that the teeth have. This has been attributed to 
the fact that he obtained most of his information 
from books, and had not the time to verify de 
scriptions that he had found. It has been argued 
from this that he was himself probably not a prac 
tical dentist, and turned to that specialty only as a 
portion of his work as a general surgeon, and that 
consequently he was not sufficiently interested to 
verify his statements. His chapters on dentistry 
would seem to bear out this conclusion to some ex 
tent, though the very fact that one who was himself 


not specially interested in dental surgery should 
have succeeded in gathering together so much that 
anticipates modern ideas in dentistry, is of itself a 
proof of how much knowledge of the subject there 
was available for a serious student of that time. 
The anatomy of the teeth continued to be rather 
vague until about the middle of the next century 
when Eustachius, whose investigations of the anat 
omy of the head have deservedly brought him fame 
and the attachment of his name to the Eustachian 
canal, wrote his " Libellus de Dentibus Manual of 
the Teeth," which is quite full, accurate, and de 
tailed. Very little has been added to the microscopic 
anatoni} of the teeth since Eustachius time. He 
had the advantage, of course, of being intimately 
in contact with the great group of Renaissance anato 
mists, Vesalius, Columbus, Varolius, Fallopius, and 
the others, the great fathers of anatomy. Besides, 
his position as Papal Physician and Professor of 
Anatomy at the Papal Medical School at Rome gave 
him opportunities for original investigation, such as 
were not easily obtained elsewhere. 

Arculanus can scarcely be blamed, therefore, for 
not having anticipated the Renaissance, and we must 
take him as merely the culmination of medieval 
knowledge with regard to anatomy and surgery. 
Medieval medical men did not have the time nor 
apparently the incentive to make formal medical 
science, though it must not be forgotten, as has been 
said, that they did use the knowledge they obtained 
by their own and others observation to excellent 
advantage for the practical benefit of ailing hu 
manity. The sciences related to medicine are con- 


scious developments that follow the evolution of 
practical medicine, nor must it be forgotten that 
far from always serving as an auxiliary to applied 
medical science, often indeed in the history of medi 
cine scientific pursuits have led men away into side 
issues from which they had to be brought back by 
some genius medical observer. As might be ex 
pected, then, it is with regard to the practical treat 
ment and general consideration of ailments of the 
teeth that Giovanni of Arcoli is most interesting. 
In this some of his chapters contain a marvellous 
series of surprises. 

Arculanus was probably born towards the end of 
the fourteenth century. The date of his death is 
variously placed as either 1460 or 1484, with the 
probability in favor of the former. From 1412 to 
1427 he was professor at Bologna, where in accord 
ance with the non-specializing tendencies of the time 
he did not occupy a single chair but several in suc 
cession. He seems first to have taught Logic, then 
Moral Philosophy, and finally Medicine. His repu 
tation in medicine drew many students to the uni 
versity, and his fame spread all over Italy. The 
rival University of Padua then secured him, and 
he seems to have been for some twenty years there. 
Later apparently he accepted a professor s chair 
at Ferrara, where the D Estes were trying to bring 
their university into prominence. It was at Fer 
rara that he died. He was a man of wide reading, 
of extensive experience, both of men and medicine, 
and one of the scholars of his time. His works are, 
as we have said, mainly excerpts from earlier writers 
and particularly the Arabians, but they contain 


enough of hints drawn from his own observation and 
experience to make his work of great value. 

While, as Gurlt remarks in his " History of Sur 
gery," Arculanus name is one of those scarcely 
known he is usually considered just one of many 
obscure writers of the end of the Middle Ages his 
writings deserve a better fate. They contain much 
that is interesting and a great deal that must have 
been of the highest practical value to his contempo 
raries. They attracted wide attention in his own 
and immediately succeeding generations. The proof 
of this is that they exist in a large number of manu 
script copies. Just as soon as printing was intro 
duced his books appeared in edition after edition. 
His " Practica " was printed in no less than seven 
editions in Venice. Three of them appeared before 
the end of the fifteenth century, which places them 
among the incunabula of printing. 

Probably nothing in the history of human intel 
lectual interest is more striking than the excellent 
judgment displayed by the editors who selected the 
works to be printed at this tune. Very few of them 
were trivial or insignificant. Fewer still were idle 
speculations, and most of them were almost of clas 
sical import for literature and science. Four edi 
tions of this work were printed in Venice in the 
sixteenth century, one of them as late as 1560, when 
the work done by such men as Vesalius, Columbus, 
Eustachius, and Fallopius would seem to have made 
Arculanus out of date. The dates of the various 
editions are Venice, 1483, 1493, 1497, 1504, 1542, 1557, 
and 1560. Besides there was an edition printed at 
Basel in 1540, 


Arculanus is said to have re-introduced the use of 
the seton, that is the method of producing intense 
counter-irritation by the introduction of some foreign 
body into an incision in the skin. We owe to him, 
too, according to Pagel in the chapters on medieval 
medicine in Puschniann s " Handbook of the History 
of Medicine," an excellent description of alcoholic 

His directions for the treatment of conditions in 
the mouth and nose apart from the teeth are quite 
as explicit and practical, and in many ways quite 
as great an anticipation of some of our modern no 
tions as what he has to say with regard to the teeth. 
For instance, in the treatment of polyps he says that 
they should be incised and cauterized. Soft polyps 
should be drawn out with a toothed tenaculum as 
far as can be without risk of breaking them off. 
The incision should be made at the root so that 
nothing or just as little as possible of the pathologi 
cal structure be allowed to remain. It should be 
cut off with a fine scissors, or with a narrow file 
just small enough to permit its ingress into the 
nostrils, or with a scalpel without cutting edges on 
the sides, but only at its extremity, and this cutting 
edge should be broad and well sharpened. If there 
is danger of hemorrhage, or if there is fear of it, 
the instruments with which dissection is made should 
be fired (igniaiitur), that is, heated at least to a dull 
redness. Afterwards the stump, if any remains, 
should be touched with a hot iron or else with 
cauterizing agents so that as far as possible it should 
be obliterated. 

After the operation a pledget of cotton dipped in 


the green ointment described by Khazes should be 
placed in the nose. This pledget should have a 
string fastened to it, hanging from the nose in order 
that it may be easily removed. At times it may be 
necessary to touch the root of the polyp with a stylet 
on which cotton has been placed that has been dipped 
in aqua fort is (nitric acid). It is important that 
this cauterizing fluid should be rather strong so that 
after a certain number of touches a rather firm 
eschar is produced. In all these manipulations in 
the nose Arculanus recommends that the nose should 
be held well open by means of a nasal speculum. 
Pictures of all these instruments occur in his extant 
works, and indeed this constitutes one of their most 
interesting and valuable features. They are to be 
seen in Gurlt s " History of Surgery," 

In some cases he had seen the polyp was so 
difficult to get at or was situated so far back in 
the nose that it could not be reached by means of a 
tenaculum or scissors, or even the special knife de 
vised for that purpose. For these patients Arcu 
lanus describes an operation that is to be found in 
the older writers on surgery, Paul of .ZEgina (J&gi- 
netus), Avicenna, and some of the other Arabian 
surgeons. For this three horse-tail hairs are twisted 
together and knotted in three or four places, and one 
end is passed through the nostrils and out through 
the mouth. The ends of this are then pulled on 
backward and forward after the fashion of a saw. 
Arculanus remarks evidently with the air of a man 
who has tried it and not been satisfied that this 
operation is quite uncertain, and seems to depend 
a great deal on chance, and much reliance must not 


be placed on it. Arculanus suggests a substitute 
method by which latent polyps or occult polyps as 
he calls them may be removed. 

There is scarcely an important disease for which 
Arculanus has not some interesting suggestions, and 
the more one reads of him the more is one surprised 
to find how many things that we might think of as 
coming into the purview of medicine long after his 
time or at least as having been neglected from the 
time of the Greeks almost down to our own time 
are here treated explicitly, definitely, and with ex 
cellent practical suggestions. He has a good deal 
to say with regard to the treatment of angina, which 
he calls synanche, or synanchia, or cynanche, or an 
gina. Parasynanche is a synonymous term, but 
refers to a milder synanche. He distinguished four 
forms of it. In one called canine angina, because 
the patient s tongue hangs out of his mouth, some 
what the same as from an overheated dog in the 
summer time, while at the same time the mouth is 
held open and he draws his breath pantingly, Arcu 
lanus suggests an unfavorable prognosis, and would 
seem to refer to those cases of Ludwig s angina in 
which there is involvement of the tongue and in which 
our prognosis continues to be of the very worst 
even to our own day. At times the angina causes 
such swelling in the throat that the breathing is 
interfered with completely. For this Arculanus 
master, Rhazes, advised tracheotomy. Arculanus 
himself, however, apparently hesitated about that. 

It is not surprising, then, to find that Arculanus 
is very explicit in his treatment of affections of the 
uvula. He divides its affections into apostema, 


ulcus, putredo sive corrosio, et casus. Apostema 
was abscess, ulcus any rather deep erosion, putredo 
a gangrenous condition, and casus the fall of the 
uvula. This is the notorious falling of the soft 
palate which has always been in popular medical 
literature at least. Arculanus describes it as a pre 
ternatural elongation of the uvula which sometimes 
goes to such an extent as to make it resemble the 
tail of a mouse. For shorter elongations he sug 
gests the cautery; for longer, excision followed by 
the cautery so that the greater portion of the ex 
tending part may be cut off. If people fear the 
knife he suggests following Rhazes, the application 
of an astringent powder directly to the part by 
blowing through a tube. His directions for the 
removal of the uvula are very definite. Seat the 
patient upon a stool in a bright light while an 
assistant holds the head; after the tongue has been 
firmly depressed by means of a speculum let the 
assistant hold this speculum in place. With the left 
hand then insert an instrument, a stilus, by which the 
uvula is pulled forward, and then remove the end 
of it by means of a heated knife or some other 
process of cauterization. The mouth should after 
wards be washed out with fresh milk. 

The application of a cauterizing solution by means 
of a cotton swab wrapped round the end of a sound 
may be of service in patients who refuse the actual 
cautery. To be successful the application must be 
firmly made and must be frequently repeated. 

After this it is not surprising to find that Arcu 
lanus has very practical chapters on all the other 
ordinary surgical affections. Empyema is treated 


very thoroughly, liver abscess, ascites, which he 
warns must be emptied slowly, ileus especially when 
it reaches stercoraceous vomiting, and the various 
difficulties of urination, he divides them into dysuria, 
ischuria, and stranguria, are all discussed in quite 
modern fashion. He gives seven causes for diffi 
culty of urination. One, some injury of the bladder ; 
two, some lesion of the urethra ; three, some patho 
logical condition in the power to make the bladder 
contract; four, some injury of the muscle of the 
neck of the bladder ; five, some pathological condition 
of the urine; six, some kidney trouble, and seven, 
some pathological condition of the general system. 
He takes up each one of these and discusses the vari 
ous phases, causes, disposition, and predispositions 
that bring them about. One thing these men of the 
Middle Ages could do, they reasoned logically, they 
ordered what they had to say well, and they wrote it 
out straightforwardly. 

That Arculanus work with regard to dentistry 
was no mere chance and not solely theoretic can 
be understood very well from his predecessors, and 
that it formed a link in a continuous tradition which 
was well preserved we may judge from what is to 
be found in the writings of his great successor, 
Giovanni or John de Vigo, who is considered one 
of the great surgeons of the early Renaissance, and 
to whom we owe what is probably the earliest treatise 
on Gun-shot Wounds. John of Vigo was a Papal 
physician and surgeon, generally considered one of 
the most distinguished members of the medical pro 
fession of his time. Two features of his writing on 
dental diseases deserve mention. He insists that 


abscesses of the gums shall be treated as other ab 
scesses by being encouraged to come to maturity and 
then being opened. If they do not close promptly, 
an irritant Egyptian ointment containing verdigris 
and alum among other things should be applied to 
them. In the cure of old fistulous tracts near the 
teeth he employs not only this Egyptian ointment 
but also arsenic and corrosive sublimate. What he 
has to say with regard to the filling of the teeth is, 
however, most important. He says it with extreme 
brevity, but with the manner of a man thoroughly 
accustomed to doing it. " By means of a drill or 
file the putrefied or corroded part of the tooth should 
be completely removed. The cavity left should then 
be rilled with gold leaf." It is evident that the 
members of the Papal court, the Cardinals and the 
Pope himself, had the advantage of rather good den 
tistry at John de Vigo s hands even as early as the 
beginning of the sixteenth century. 

John de Vigo, however, is not medieval. He lived 
on into the sixteenth century and was influenced 
deeply by the Kenaissance. He counts among the 
makers of modern medicine and surgery, as his 
authorship of the treatise on gun-shot wounds makes 
clear. He comes in a period that will be treated of 
in a later volume of this series on Our Forefathers 
in Medicine. 



As illustrating how, as we know more about 
the details of medical history, the beginnings of 
medical science and medical practice are pushed 
back farther and farther, a discussion in the Ber 
liner klinische Wochenschrift a dozen years ago is 
of interest. Professor Ernest von Leyden, in sketch 
ing the history of the taking of the pulse as an impor 
tant aid in diagnostics, said that John Floyer was 
usually referred to as the man who introduced the 
practice of determining the pulse rate by means of 
the watch. His work was done about the beginning of 
the eighteenth century. Professor von Leyden sug 
gested, however, that William Harvey, the English 
physiologist, to whom is usually attributed the dis 
covery of the circulation of the blood, had empha 
sized the value of the pulse in medical diagnosis, 
and also suggested the use of the watch in counting 
the pulse. Professor Carl Binz, of the University of 
Bonn, commenting on these remarks of Professor 
von Leyden, called attention to the fact that more 
than a century before the birth of either of thesemen, 
even the earlier, to whom the careful measurement 
of the pulse rate is thus attributed as a discovery, 
a distinguished German churchman, who died 
shortly after the middle of the fifteenth century, had 



suggested a method of accurate estimation of the 
pulse that deserves a place in medical history. 

This suggestion is so much in accord with modern 
demands for greater accuracy in diagnosis that it 
seems not inappropriate to talk of it as the first 
definite attempt at laboratory methods in the de 
partment of medicine. The maker of the sugges 
tion, curiously enough, was not a practising physi 
cian, but a mathematician and scholar, Cardinal 
Nicholas of Cusa, who is known in history as 
Cusanus from the Latin name of the town Cues on 
the Moselle Eiver, some twenty-five miles south of 
Treves, where he was born. His family name, 
Nicholas Krebs, has been entirely lost sight of in 
the name derived from his native town, which is the 
only reason why most of the world knows anything 
about that town. Cardinal Cusanus suggested that 
in various forms of disease and at various times of 
life, as in childhood, boyhood, manhood, and old 
age, the pulse was very different. It would be ex 
tremely valuable to have some method of accurately 
estimating, measuring, and recording these differ 
ences for medical purposes. At that time watches 
had not yet been invented, and it would have been 
very difficult to have estimated the time by the 
clocks, for almost the only clocks in existence were 
those in the towers of the cathedrals and of the pub 
lic buildings. The first watches, Nuremberg eggs, 
as they were called, were not made by Peter Hen- 
lein until well on into the next century. The only 
method of measuring time with any accuracy in 
private houses was the clepsydra or water-clock, 
which measured the time intervals by the flow of a 


definite amount of water. Cardinal Cusanus sug 
gested then that the water-clock should be employed 
for estimating the pulse frequency. His idea was 
that the amount of water which flowed while a hun 
dred heats of the pulse were counted, should be 
weighed, and this weight compared with that of 
the average weight of water which flowed while a 
hundred beats of the normal pulse of a number of 
individuals of the same age and constitution were 
being counted. 

This was a very simple and a very ingenious sug 
gestion. "\Ve have no means of knowing now 
whether it was adopted to any extent or not. It 
may seem rather surprising that a cardinal should 
have been the one to make such a suggestion. 
Cusanus, however, was very much interested in 
mathematics and in the natural sciences, and we 
have many wonderful suggestions from his pen. 
He was the first, for instance, to suggest, more than 
a century before Copernicus, that the earth was not 
the centre of the universe, and that it would not be 
absolutely at rest or, as he said, devoid of all mo 
tion. His words are: " Terra igitur, qua centrum 
esse nequit, motu omni carere non potest." He de 
scribed very clearly how the earth moved round its 
own axis, and then he added, what cannot fail to be a 
surprising declaration for those in the modern times 
who think such an idea of much later origin, that he 
considered that the earth itself cannot be fixed, but 
moves as do the other stars in the heavens. The 
expression is so astonishing at that time in the 
world s history that it seems worth the while to 
give it in its original form, so that it may be seen 


clearly that it is not any subsequent far-fetched in 
terpretation of his opinion, but the actual words 
themselves, that convey this idea. He said: " Con- 
sideravi quod terra ista non potest esse fixa, sed 
movetur ut alia stellce." 

How clearly Cusanus anticipated another phase 
of our modern views may be judged from what he 
has to say in " De Docta Ignorantia " with regard to 
the constitution of the sun. It is all the more sur 
prising that he should by some form of intuition 
reach such a conclusion, for the ordinary sources of 
information with regard to the sun would not sug 
gest such an expression except to a genius, whose 
intuition outran by far the knowledge of his time. 
The Cardinal said: " To a spectator on the surface 
of the sun the splendor which appears to us would 
be invisible, since it contains, as it were, an earth 
for its central mass, with a circumferential envelope 
of light and heat, and between the two an atmos 
phere of water and clouds and of ambient air." 
After reading that bit of precious astronomical sci 
ence announced nearly five centuries ago, it is easy 
to understand how Copernicus could have an 
ticipated other phases of our knowledge, as he did 
in his declarations that the figure of the earth is 
not a sphere, but is somewhat irregular, and that 
the orbit of the earth is not circular. 

Cusanus was an extremely practical man, and was 
constantly looking for and devising methods of ap 
plying practical principles of science to ordinary 
life. As we shall see in discussing his suggestion 
for the estimation of the pulse rate later on, he 
made many other similar suggestions for diagnostic 


purposes in medicine, and set forth other applica 
tions of mathematics and mechanics to his genera 

Many of Cusanus books have curiously modern 
names. He wrote, for instance, a series of mathe 
matical treatises, in Latin of course, on " Geometric 
Transmutations," on " Arithmetical Comple 
ments," on " Mathematical Complements," on 
" Mathematical Perfection," and on " The Correc 
tion of the Calendar." In his time the calendar was 
in error by more than nine days, and Cusanus was 
one of those who aroused sufficient interest in the 
subject, so that in the next century the correction 
was actually made by the great Jesuit mathemati 
cian, Father Clavius. Perhaps the work of Cusanus 
that is best known is that On Learned Ignorance 
De Docta Ignorantia," in which the Cardinal points 
out how many things that educated people think they 
know are entirely wrong. It reminds one very much 
of Josh Billings s remark that it is not so much the 
ignorance of mankind that makes them ridiculous, 
as the knowing so many things that ain t so. It is 
from this work that the astronomical quotations 
which we have made are taken. The book that is of 
special interest to physicians is his dialogue " On 
Static Experiments," which he wrote in 1450, and 
which contains the following passages : 

" Since the weight of the blood and the urine of 
a healthy and of a diseased man, of a young man 
and an old man, of a German and an African, is 
different for each individual, why would it not be 
a great benefit to the physician to have all of these 
various differences classified! For I think that a 


physician would make a truer judgment from the 
weight of the urine viewed in connection with its 
color than he could make from its color alone, which 
might be fallacious. So, also, weight might be used 
as a means of identifying the roots, the stems, the 
leaves, the fruits, the seeds, and the juice of plants 
if the various weights of all the plants were properly 
noted, together with their variety, according to lo 
cality. In this way the physician would appreciate 
their nature better by means of their weight than 
if he judged them by their taste alone. He might 
know, then, from a comparison of the weights of 
the plants and their various parts when compared 
with the weight of the blood and the urine, how to 
make an application and a dosage of drugs from the 
concordances and differences of the medicaments, 
and even might be able to make an excellent prog 
nosis in the same way. Thus, from static experi 
ments, he would approach by a more precise knowl 
edge to every kind of information. 

Do you not think if you would permit the water 
from the narrow opening of a clepsydra [water- 
clock] to flow into a basin for as long as was neces 
sary to count the pulse a hundred times in a healthy 
young man, and then do the same thing for an ail 
ing young man, that there would be a noticeable dif 
ference between the weights of the water that would 
flow during the period? From the weight of the 
water, therefore, one would arrive at a better knowl 
edge of the differences in the pulse of the young and 
the old, the healthy and the unhealthy, and so, also, 
as to information with regard to various diseases, 
since there would be one weight and, therefore, one 
pulse in one disease, and another weight and another 
pulse in another disease. In this way a better judg 
ment of the differences in the pulse could be ob 
tained than from the touch of the vein, just as more 
can be known from the urine about its weight than 
from its color alone. 


" Just in the same way would it not be possible 
to make a more accurate judgment with regard to 
the breathing, if the inspirations and expirations 
were studied according to the weight of the water 
that passed during a certain interval! If, while 
water was flowing from a clepsydra, one were to 
count a hundred expirations in a boy, and then in 
an old man, of course, there would not be the same 
amount of water at the end of the enumeration. 
Then this same thing might be done for other ages 
and states of the body. As a consequence, when 
the physician once knew what the weight of water 
that represented the number of expirations of a 
healthy boy or youth, and then of an individual of 
the same age ill of some infirmity or other, there is 
no doubt that, by this observation, he will come to 
a knowledge of the health or illness and something 
about the case, and, perhaps, also with more cer 
tainty would be able to choose the remedy and the 
dose required. If he found in a healthy young 
man apparently the same weight as in an old and 
decrepit individual, he might readily be brought to 
the conclusion that the young man would surely die, 
and in this way have some evidence for his prog 
nosis in the case. Besides, if in fevers, in the same 
way, careful studies were made of the differences 
in the weight of water for pulse and respiration in 
the warm and the cold paroxysms, would it not be 
possible thus to know the disease better and, per 
haps, also get a more efficacious remedy? " 

As will be seen from this passage, Cusanus had 
many more ideas than merely the accurate estima 
tion of the pulse frequency when he suggested the 
use of the water-clock. Evidently the thought had 
come to him that the specific gravity of the sub 
stances, that is, their weight in comparison to the 
weight of water, might be valuable information. 


Before his time, physicians had depended only on 
the color and the taste of the urine for diagnostic 
purposes. He proposed that they should weigh it, 
and even suggested that they should weigh, also, the 
blood, I suppose in case of venesection, for com 
parison s sake. He also thought that the compara 
tive weight of various roots, stems, leaves, juices of 
plants might give hints for the therapeutic uses of 
these substances. This is the sort of idea that we 
are apt to think of as typically modern. Specific 
gravities and atomic weights have been more than 
once supposed to represent laws in therapeutics, 
which so far, however, we have not succeeded in 
finding, but it is interesting to realize that it is 
nearly five hundred years since the first thought in 
this line was clearly expressed by a distinguished 
thinker and scientific writer. 

There are many interesting expressions in 
Cusanus writings which contradict most of the im 
pressions commonly entertained with regard to the 
scholars of the Middle Ages. It is usually assumed 
that they did not think seriously, but speculatively, 
that they feared to think for themselves, neglected 
the study of nature around them, considered author 
ity the important source of knowledge, and were as 
far as possible from the standpoint of modern sci 
entific students and investigators. Here is a 
passage from Nicholas, on knowing and thinking, 
that might well have been written by a great intel 
lectual man at any time in the world s history, and 
that could only emanate from a profound scholar at 
any time. 


To know and to think, to see the truth with the 
eye of the mind, is always a joy. The older a man 
grows the greater is the pleasure which it affords 
him, and the more he devotes himself to the search 
after truth, the stronger grows his desire of pos 
sessing it. As love is the life of the heart, so is the 
endeavor after knowledge and truth the life of the 
mind. In the midst of the movements of time, of 
the daily work of life, of its perplexities and con 
tradictions, we should lift our gaze fearlessly to 
the clear vault of heaven, and seek ever to obtain a 
firmer grasp of and a keener insight into the origin 
of all goodness and beauty, the capacities of our 
own hearts and minds, the intellectual fruits of 
mankind throughout the centuries, and the wondrous 
works of nature around us; at the same time re 
membering always that in humility alone lies true 
greatness, and that knowledge and wisdom are alone 
profitable in so far as our lives are governed by 

The career of Nicholas of Cusa is interesting, be 
cause it sums up so many movements, and, above all, 
educational currents in the fifteenth century. He 
was born in the first year of the century, and lived 
to be sixty-four. He was the son of a wine grower, 
and attracted the attention of his teachers because 
of his intellectual qualities. In spite of compara 
tively straitened circumstances, then, he was af 
forded the best opportunities of the time for educa 
tion. He went first to the school of the Brethren 
of the Common Life at Deventer, the intellectual 
cradle of so many of the scholars of this century. 
Such men as Erasmus, Conrad Mutianus, Johann 
Sintheim, Hermann von dem Busche, whom Strauss 
calls " the missionary of human wisdom," and the 


teacher of most of these, Alexander Hegius, who 
has been termed the schoolmaster of Germany, with 
Nicholas of Cusa and Rudolph Agricola and others, 
who might readily be mentioned, are the fruits of 
the teaching of these schools of the Brethren of the 
Common Life, in one of which Thomas a Kempis, 
the author of " The Imitation of Christ," was, for 
seventy years out of his long life of ninety, a teacher. 
Cusanus succeeded so well at school that he was 
later sent to the University of Heidelberg, and sub 
sequently to Padua, where he took up the study of 
Roman law, receiving his doctorate at the age of 
twenty-three. This series of educational oppor 
tunities will be surprising only to those who do not 
know educational realities at the beginning of the 
fifteenth century. There has never been a time 
when a serious seeker after knowledge could find 
more inspiration. On his return to Germany, 
Father Krebs became canon of the cathedral in 
Coblenz. This gave him a modest income, and 
leisure for intellectual work which was eagerly 
employed. He was scarcely more than thirty when 
he was chosen as a delegate to the Council at Basel. 
After this he was made Archdeacon of the Cathedral 
of Liittich, and from this time his rise in ecclesi 
astical preferment was rapid. He had attracted so 
much attention at the Council of Basel that he was 
chosen as a legate of the Pope for the bringing about 
certain reforms in Germany. Subsequently he was 
sent on ecclesiastical missions to the Netherlands, 
and even to Constantinople. At the early age of 
forty he was made a Cardinal. After this he was 
always considered as one of the most important 


consultors of the Papacy in all matters relating to 
Germany. During the last twenty-five y-ears of his 
life in all the relations of the Holy See to Ger 
many, appeal was constantly made to the wisdom, 
the experience, and the thoroughly conservative, 
yet foreseeing, judgment of this son of the people, 
whose education had lifted him up to be one of the 
leaders of men in Europe. 

It was during this time that he wrote most of his 
books on mathematics, which have earned for him 
a prominent place in Cantor s " History of Mathe 
matics," about a score of pages being devoted to 
his work. Much of his thinking was done while 
riding on horseback or in the rude vehicles of the 
day on the missions to which he was sent as Papal 
Legate. He is said to have worked out the formula 
for the cycloid curve while watching the path de 
scribed by flies that had lighted on the wheels of his 
carriage, and were carried forward and around by 
them. His scientific books, though they included 
such startling anticipations of Copernicus doc 
trines as we have already quoted (Copernicus did 
not publish the first sketch of his theory for more 
than a quarter of a century after Cusanus death), 
far from disturbing his ecclesiastical advancement 
or injuring his career as a churchman, seem actu 
ally to have been considered as additional reasons 
for considering him worthy of confidence and con 

As the result of his careful studies of conditions 
in Germany, he realized very clearly how much of 
unfortunate influence the political status of the Ger 
man people, with their many petty rulers and the 


hampering of development consequent upon the 
trivial rivalries, the constant bickerings, and the 
inordinate jealousies of these numerous princelings, 
had upon his native country. Accordingly, towards 
the end of his life he sketched what he thought 
would be the ideal political status for the German 
people. As in everything that he wrote, he went 
straight to the heart of the matter and, without 
mincing words, stated just exactly what he thought 
ought to be done. Considering that this scheme 6f 
Cusanus for the prosperity and right government of 
the German people was not accomplished until more 
than four centuries after his death, it is interesting, 
indeed, to realize how this clergyman of the middle 
of the fifteenth century should have come to any 
such thought. Nothing, however, makes it clearer 
than this, that it is not time that fosters thinking, 
but that great men at any time come to great 
thoughts. Cusanus wrote: 

" The law and the kingdom should be placed under 
the protection of a single ruler or authority. The 
small separate governments of princes and counts 
consume a disproportionately large amount of rev 
enue without furnishing any real security. For this 
reason we must have a single government, and for 
its support we must have a definite amount of the 
income from taxes and revenues yearly set aside by 
a representative parliament and before this parlia 
ment (reichstag) must be given every year a definite 
account of the money that was spent during the pre 
ceding year." 

Cusanus life and work stand, then, as a type of 
the accomplishment, the opportunities, the power of 
thought, the practical scholarship, the mathematical 


accuracy, the fine scientific foresight of a scholar of 
the fifteenth century. For us, in medicine, it is in 
teresting indeed to realize that it is from a man of 
this kind that a great new departure in medicine 
with regard to the employment of exact methods of 
diagnosis had its first suggestion in modern times. 
The origin of that suggestion is typical. It has 
practically always been true that it was not the 
man who had exhausted, or thought that he had done 
so, all previous medical knowledge, who made ad 
vances in medicine for us. It has nearly always 
been a young man early in his career, and at a time 
when, as yet, his mind was not overloaded with the 
medical theories of his own time. Cusanus was 
probably not more than thirty when he made the 
suggestion which represents the first practical hint 
for the use of laboratory methods in modern medi 
cine. It came out of his thoughtful consideration of 
medical problems rather than from a store of gar 
nered information as to what others thought. It is 
a lesson in the precious value of breadth of educa 
tion and serious training of mind for real progress 
at all times. 



" Fieri enim potest ut operator erret et a via 
regia deflectat, sed ut erret natura quando recte 
tractatur fieri non potest." 

" For it is quite possible that the physician should 
err and be turned aside from the straight (royal) 
road, but that nature when she is rightly treated 
should err is quite impossible." 

This is one of the preliminary maxims of a 
treatise on medicine written by a physician born 
not later than the first half of the fifteenth century, 
and who may have lived even somewhat earlier. ~\Ve 
are so prone to think of the men of that time as 
utterly dependent on authority, not daring to follow 
their own observation, suspecting nature, and al 
most sure to be convinced that only by going counter 
to her could success in the treatment of disease be 
obtained, that it is a surprise to most people to find 
how completely the attitude of mind, that is sup 
posed to be so typically modern in this regard, was 
anticipated full four centuries ago. There are 
other expressions of this same great physician and 
medical writer, Basil Valentine, which serve to show 
how faithfully he strove with the lights that he had 
to work out the treatment of patients, just as we do 
now, by trying to find out nature s way, so as to 



imitate her beneficent processes and purposes. It 
is quite clear that he is but one of many faithful, 
patient observers and experimenters true sci 
entists in the best sense of the word who lived in 
all the centuries of the Middle Ages. 

Speculations and experiments with regard to the 
elixir of life, the philosopher s stone, and the trans 
mutation of metals, are presumed to have filled up 
all the serious interests of the alchemists, supposed 
to be almost the only scientists of those days. As 
a matter of fact, however, men were making original 
observations of profound significance, and these 
were considered so valuable by their contemporaries 
that, though printing had not yet been invented, 
even the immense labor involved in the manifold 
copying of large folio volumes by the slow hand 
process did not suffice to deter them from multiply 
ing the writings of these men so numerously that 
they were preserved in many copies for future gen 
erations, until the printing press came to perpetuate 

Of this there is abundant evidence in the preced 
ing pages as regards medicine, and, above all, 
surgery, while a summary of accomplishments of 
workers in other departments will be found in Ap 
pendix II, " Science at the Medieval Universities." 

At the beginning of the twentieth century, with 
some of the supposed foundations of modern chem 
istry crumbling to pieces under the influence of the 
peculiarly active light thrown upon our nineteenth 
century chemical theories by the discovery of 
radium, and our observations on radio-active ele 
ments generally, there is a reawakening of interest 


in some of the old-time chemical observers, whose 
work used to be laughed at as so unscientific, or, at 
most, but a caricature of real science, and whose 
theory of the transmutation of elements into one 
another was considered so absurd. It is interesting 
in the light of this to recall that the idea that the 
elementary substances were essentially distinct 
from each other, and that it would be impossible un 
der any circumstances to convert one element into 
another, belongs entirely to the nineteenth century. 
Even so deeply scientific a mind as that of Newton, 
in the preceding century, could not bring itself to 
acknowledge the tradition, that came to be accepted 
subsequent to his time, of the absurdity of metallic 
transformation. On the contrary, he believed quite 
formally in transmutation as a basic chemical prin 
ciple, and declared that it might be expected to occur 
at any time. He had seen specimens of gold ores in 
connection with metallic copper, and concluded that 
this was a manifestation of the natural transforma 
tion of one of these yellow metals into the other. 

With the discovery that radium transforms itself 
into helium, and that, indeed, all the so-called radio 
activities of the heavy metals are probably due to a 
natural transmutation process constantly at work, 
the ideas of the older chemists cease entirely to be a 
subject for amusement. The physical chemists of 
the present day are very ready to admit that the 
old teaching of the absolute independence of some 
thing over seventy elements is no longer tenable, 
except as a working hypothesis. The doctrine of 
" matter and form," taught for so many centuries 
by the scholastic philosophers, which proclaimed 


that all matter is composed of two principles, an 
underlying material substratum, and a dynamic or 
informing principle, has now more acknowledged 
verisimilitude, or lies at least closer to the gener 
ally accepted ideas of the most progressive sci 
entists, than it has at any time for the last two or 
three centuries. Not only the great physicists, but 
also the great chemists, are speculating along lines 
that suggest the existence of but one form of mat 
ter, modified according to the energies that it pos 
sesses under a varying physical and chemical en 
vironment. This is, after all, only a restatement in 
modern times of the teaching of St. Thomas of 
Aquin, in the thirteenth century. 

It is not surprising, then, that there should be a 
reawakening of interest in the lives of some of the 
men, who, dominated by some of the earlier scho 
lastic ideas, by the tradition of the possibility of 
rinding the philosopher s stone, which would trans 
mute the baser metals into the precious metals, de 
voted themselves with quite as much zeal as any 
modern chemist to the observation of chemical 
phenomena. One of the most interesting of these 
indeed, he might well be said to be the greatest of 
the alchemists is the man whose only name that we 
know is that which appears on a series of manu 
scripts written in the High German dialect of the 
end of the fifteenth and the beginning of the six 
teenth century. That name is Basil Valentine, and 
the writer, according to the best historical tradi 
tions, was a Benedictine monk. The name Basil 
Valentine may only have been a pseudonym, for it 
has been impossible to trace it among the records of 


the monasteries of the time. That the writer was 
a monk, however, there seems to be no room for 
doubt, for his writings give abundant evidence of it, 
and, besides, in printed form they began to have 
their vogue at a time when there was little likelihood 
of their being attributed to a monastic source, un 
less an indubitable tradition connected them with 
some monastery. 

This Basil Valentine (to accept the only name we 
have) did so much for the science of the composition 
of substances that he eminently deserves the desig 
nation that has been given him of the last of the 
alchemists and the first of the chemists. There is 
practically a universal recognition of the fact now 
that he deserves also the title of the Founder of 
Pharmaceutical Chemistry, not only because of the 
value of the observations contained in his writings, 
but also because of the fact that they proved so sug 
gestive to certain scientific geniuses during the cen 
tury succeeding Valentine s life. Almost more than 
to have added to the precious heritage of knowledge 
for mankind, it is a boon for a scientific observer to 
have awakened the spirit of observation in others, 
and to be the founder of a new school of thought. 
This Basil Valentine undoubtedly did, and, in the 
Renaissance, the incentive from his writings for 
such men as Paracelsus is easy to appreciate. 

Besides, his work furnishes evidence that the in 
vestigating spirit was abroad just when it is usually 
supposed not to have been, for the Thuringian monk 
surely did not do all his investigation alone, but 
must have .owed, as well as given, many a suggestion 
to his contemporaries. 


Some ten years ago, when Sir Michael Foster, 
professor of physiology in the University of Cam 
bridge, England, was invited to deliver the Lane 
Lectures at the Cooper Medical College in San Fran 
cisco, he took for his subject " The History of 
Physiology." In the course of his lecture on " The 
Rise of Chemical Physiology " he began with the 
name of Basil Valentine, who first attracted men s 
attention to the many chemical substances around 
them that might be used in the treatment of disease, 
and said of him: 

" He was one of the alchemists, but in addition to 
his inquiries into the properties of metals and his 
search for the philosopher s stone, he busied himself 
with the nature of drugs, vegetable and mineral, and 
with their action as remedies for disease. He was 
no anatomist, no physiologist, but rather what now 
adays we should call a pharmacologist. He did not 
care for the problem of the body, all he sought to 
understand was how the constituents of the soil and 
of plants might be treated so as to be available for 
healing the sick and how they produced their effects. 
We apparently owe to him the introduction of many 
chemical substances, for instance of hydrochloric 
acid, which he prepared from oil and vitriol of salt, 
and of many vegetable drugs. And he was appar 
ently the author of certain conceptions which, as we 
shall see, played an important part in the develop 
ment of chemistry and of physiology. To him, it 
seems, we owe the idea of the three elements, as 
they were and have been called, replacing the old 
idea of the ancients of the four elements earth, air, 
fire, and water. It must be remembered, however, 
that both in the ancient and the new idea the word 
1 element was not intended to mean that which it 
means to us now, a fundamental unit of matter, but 


a general quality or property of matter. The three 
elements of Valentine were: (1) sulphur, or that 
which is combustible, which is changed or destroyed, 
or which at all events disappears during burning or 
combustion; (2) mercury, that which temporarily 
disappears during burning or combustion, which is 
dissociated in the burning from the body burnt, but 
which may be recovered, that is to say, that which is 
volatile, and (3) salt, that which is fixed, the residue 
or ash which remains after burning." 

It is a little bit hard in our time for most people 
to understand just how such a development of thor 
oughly scientific chemical notions, with investiga 
tions for their practical application, should have 
come before the end of the Middle Ages. This diffi 
culty of understanding, however, we are coming to 
realize in recent years, is entirely due to our ig 
norance of the period. We have known little or 
nothing about the science of the Middle Ages, be 
cause it was hidden away in rare old books, in rather 
difficult Latin, not easy to get at, and still less easy 
to understand always, and we have been prone to 
conclude that since we knew nothing about it, there 
must have been nothing. Just inasmuch as we have 
learned something definite about the medieval 
scholars, our admiration has increased. Professor 
Clifford Allbutt, the Regius Professor of Medicine 
at the University of Cambridge, in his Harveian 
Oration, delivered before the Royal College of Phy 
sicians in 1900, on " Science and Medieval 
Thought " (London, 1901), declared that " the 
schoolmen, in digging for treasure, cultivated the 
field of knowledge even for Galileo and Harvey, for 
Newton and Darwin." He might have added that 


they had laid foundations in all our modern sciences, 
in chemistry quite as well as in astronomy, physi 
ology, and the medical sciences, in mathematics and 

In chemistry the advances made during the 
thirteenth, fourteenth, and fifteenth centuries were, 
perhaps, even more noteworthy than those in any 
other department of science. Albertus Magnus, who 
taught at Paris, wrote no less than sixteen treatises 
on chemical subjects, and, notwithstanding the fact 
that he was a theologian as well as a scientist, and 
that his printed works fill some fifteen folio volumes, 
he somehow found the time to make many observa 
tions for himself, and performed numberless ex 
periments in order to clear up doubts. The larger 
histories of chemistry accord him his proper place, 
and hail him as a great founder in chemistry, and a 
pioneer in original investigation. 

Even St. Thomas of Aquin, much as he was oc 
cupied with theology and philosophy, found some 
time to devote to chemical questions. After all, 
this is only what might have been expected of the 
favorite pupil of Albertus Magnus. Three treatises 
on chemical subjects from Aquinas pen have been 
preserved for us, and it is to him that we are said 
to owe the use, in the "Western world at least, of the 
word amalgam, which he first employed in describ 
ing various chemical methods of metallic combina 
tion with mercury that were discovered in the search 
for the genuine transmutation of metals. 

Albertus Magnus other great scientific pupil, 
Koger Bacon, the English Franciscan friar, followed 
more closely in the scientific ways of his great 


master, devoting himself almost entirely to the 
physical sciences. Altogether he wrote some 
eighteen treatises on chemical subjects. For a long 
time it was considered that he was the inventor of 
gunpowder, though this is now known to have been 
introduced into Europe by the Arabs. Roger Ba 
con studied gunpowder and various other explosive 
combinations in considerable detail, and it is for this 
reason that he obtained the undeserved reputation 
of being an original discoverer in this line. How 
well he realized how much might be accomplished by 
means of the energy stored tip in explosives, can, 
perhaps, be best appreciated from the fact that he 
suggested that boats would go along the rivers and 
across seas without either sails or oars, and that 
carriages would go along the streets without horse 
or man power. He considered that man would 
eventually invent a method of harnessing these ex 
plosive mixtures, and of utilizing their energies for 
his purposes without danger. It is curiously inter 
esting to find, as we begin the twentieth century, and 
gasolene is so commonly used for the driving of 
automobiles and motor boats, and is being introduced 
even into heavier transportation as the most avail 
able source of energy for suburban traffic, at least, 
that this generation should only be fulfilling the idea 
of the old Franciscan friar of the thirteenth century, 
who prophesied that in explosives there was the 
secret of eventually manageable energy for trans 
portation purposes. 

Succeeding centuries were not as fruitful in great 
scientists as the thirteenth, and yet, in the second 
half of the thirteenth, there was a Pope, John XXI, 


who had been a physician and professor of medicine 
before his election to the Papacy, three of whose 
scientific treatises one on the transmutation of 
metals, which he considers an impossibility, at least 
as far as the manufacture of gold and silver was 
concerned; a treatise on diseases of the eyes, to 
which good authorities have not hesitated to give 
lavish praise for its practical value, considering the 
conditions in which it was written ; and, finally, his 
treatise on the preservation of the health, written 
when he was himself over eighty years of age 
are all considered by good authorities as worthy of 
the best scientific spirit of the time. 

During the fourteenth century, Arnold of Vil- 
lanova, the inventor of nitric acid, and the two Hol- 
landuses, kept up the tradition of original investiga 
tion in chemistry. Altogether there are some 
dozen treatises from these three men on chemical 
subjects. The Hollanduses particularly did their 
work in a spirit of thoroughly frank, original in 
vestigation. They were more interested in min 
erals than in any other class of substances, but did 
not waste much time on the question of transmuta 
tion of metals. Professor Thompson, the professor 
of chemistry at Edinburgh, said, in his " History of 
Chemistry," many years ago, that the Hollanduses 
give very clear descriptions of their processes of 
treating minerals in investigating their composition, 
and these serve to show that their knowledge was 
by no means entirely theoretical, or acquired only 
from books. 

It is not surprising, then, to have a great in 
vestigating pharmacologist come along sometime 


about the beginning of the fifteenth century, when, 
according to the best authorities, Basil Valentine 
was born. From traditions he seems to have had a 
rather long life, and his years run nearly parallel 
with his century. His career is a typical example 
of the personally obscure and intellectually bril 
liant lives which the old monks lived. Probably 
in nothing have recent generations been more de 
ceived in historical matters than in their estimation 
of the intellectual attainments and accomplishment 
of the old monks. The more that we know of them, 
not from second-hand authorities, but from their 
own books and from what they accomplished in art 
and architecture, in agriculture, in science of all 
kinds, the more do we realize what busy men they 
were, and appreciate what genius they often brought 
to the solution of great problems. "We have had 
much negative pseudo-information brought together 
with the definite purpose of discrediting monasti- 
cism, and now that positive information is gradu 
ally being accumulated, it is almost a shock to find 
how different are the realities of the story of the 
intellectual life during the Middle Ages from what 
many writers had pictured them. 

To those who may be surprised that a man who 
did great things in medicine should have lived dur 
ing the fifteenth century, it may be well to recall 
the names and a little of the accomplishment of the 
men of this period, who were Basil Valentine s con 
temporaries, at least in the sense that some portion 
of their lives and influence was coeval with his. 
Before the end of this century Columbus had dis 
covered America, and by no happy accident, for 


many men of his generation did correspondingly 
great work. Cardinal Nicholas of Cusa had de 
veloped mathematics and applied mathematical 
ideas to the heavens, so that he could announce the 
conclusion that the earth was a star, like the other 
stars, and moved in the heavens as they do. Con 
temporary with Cusanus was Kegiomontanus, who 
has been proclaimed the father of modern astron 
omy, and a distinguished mathematician. Tos- 
canelli, the Florentine astronomer, whose years run 
almost parallel with those of the fifteenth century, 
did fine scholarly work, which deeply influenced Co 
lumbus and the great navigators of the time. The 
universities in Italy were attracting students from 
all over Europe, and such men as Linacre and Dr. 
Caius went down there from England. Eaphael 
was but a young man at the end of the century, but 
he had done some noteworthy painting before it 
closed. Leonardo da Vinci was born just about 
the middle of the century, and did some marvellous 
work before the end of that century. Michael 
Angelo was only twenty-five at the close of the 
century, but he, too, did fine work, even at this 
early age. Among the other great Italian painters 
of this century are Fra Angelico, Perugino, 
Raphael s master, Pinturicchio, Signorelli, the pupil 
of his uncle, Vasari, almost as distinguished, Botti 
celli, Titian, and very many others, who would have 
been famous leaders in art in any other but this 
supremely great period. 

It was not only in Italy, however, that there was 
a wonderful outburst of genius at this time, for 
Germany also saw the rise of a number of great 


men during this period. Jacob Wimpheling, the 
" Schoolmaster of Germany," as he has been called, 
whose educational work did much to determine the 
character of German education for two centuries, 
was born in 1450. Eudolph Agricola, who in 
fluenced the intellectual Europe of this time deeply, 
was born in 1443. Erasmus, one of the greatest of 
scholars, of teachers, and of controversialists, was 
born in 1467. Johann Reuchlin, the great linguist, 
who, next to Erasmus, is the most important char 
acter in the German Renaissance, was born in 1455. 
Then there was Sebastian Brant, the author of " The 
Ship of Fools," and Alexander Hegius, both of this 
same period. The most influential of them all, 
Thomas a Kempis, who died in 1471, and whose 
little book, " The Following of Christ," has in 
fluenced every generation deeply ever since, was 
probably a close contemporary of Basil Valentine. 
When one knows what European, and especially 
German scholars, were accomplishing at this time, 
no room is left for surprise that Basil Valentine 
should have lived and done work in medicine at this 
period that was to influence deeply the after history 
of medicine. 

Most of what Basil Valentine did was accom 
plished in the first half of the fifteenth century. 
Coming, as he did, before the invention of printing, 
when the spirit of tradition was more rife and dom 
inating than it has been since, it is almost needless to 
say that there are many curious legends associated 
with his name. Two centuries before his time, 
Roger Bacon, doing his work in England, had suc 
ceeded in attracting so much attention even from 


the common people, because of his wonderful sci 
entific discoveries, that his name became a byword, 
and many strange magical feats were attributed to 
him. Friar Bacon was the great wizard, even in 
the plays of the Elizabethan period. A number of 
the same sort of myths attached themselves to the 
Benedictine monk of the fifteenth century. He was 
proclaimed in popular story to have been a won 
derful magician. Even his manuscript, it was said, 
had not been published directly, but had been hid 
den in a pillar in the church attached to his 
monastery, and had been discovered there after the 
splitting open of the pillar by a bolt of lightning 
from heaven. It is the extension of this tradition 
that has sometimes led to the assumption that Val 
entine lived in an earlier century, some even going 
so far as to say that he, too, like Roger Bacon, was 
a product of the thirteenth century. It seems rea 
sonably possible, however, to separate the tradi 
tional from what is actual in his existence, and thus 
to obtain some idea at least of his work, if not of 
the details of his life. The internal evidence from 
his works enables the historian of science to place his 
writing within half a century of the discovery of 

One of the myths that have gathered around the 
name of Basil Valentine, because it has become a 
commonplace in philology, has probably made him 
more generally known than any of his actual dis 
coveries. In one of the most popular of the old- 
fashioned text-books of chemistry in use about half 
a century ago, in the chapter on antimony, there 
was a story that students, if I may judge from my 


own. experience, never forgot. It was said that 
Basil Valentine, a monk of the Middle Ages, was 
the discoverer of this substance. After having ex 
perimented with it in a number of ways, he threw 
some of it out of his laboratory one day when the 
swine of the monastery, finding it, proceeded to gob 
ble it up, together with some other refuse. Just when 
they were finishing it, the monk discovered what they 
were doing. He feared the worst from it, but took 
the occasion to observe the effect upon the swine 
very carefully. He found that, after a preliminary 
period of digestive disturbance, these swine de 
veloped an enormous appetite, and became fatter 
than any of the others. This seemed a rather de 
sirable result, and Basil Valentine, ever on the 
search for the practical, thought that he might use 
the remedy to good purpose on the members of the 
community. Some of the monks in the monastery 
were of rather frail health and delicate constitution, 
and most of them were rather thin, and he thought 
that the putting on of a little fat, provided it could 
be accomplished without infringement of the rule, 
might be a good thing for them. Accordingly, he 
administered, surreptitiously, some of the salts of 
antimony, with which he was experimenting, in the 
food served to these monks. The result, however, 
was not so favorable as in the case of the hogs. In 
deed, according to one, though less authentic, ver 
sion of the story, some of the poor monks, the un 
conscious subjects of the experiment, perished as 
the result of the ingestion of the antimonial com 
pounds. According to the better version, they suf 
fered only the usual unpleasant consequences of 


taking antimony, which are, however, quite enough 
for a fitting climax to the story. Basil Valentine 
called the new substance which he had discovered 
antimony, that is, opposed to monks. It might be 
good for hogs, but it was a form of monks bane, as 
it were. 1 

Unfortunately for most of the good stories of 
history, modern criticism has nearly always failed 
to find any authentic basis for them, and they have 
had to go the way of the legends of Washington s 
hatchet and Tell s apple. We are sorry to say that 
that seems to be true also of this particular story. 
Antimony, the word, is very probably derived from 
certain dialectic forms of the Greek word for the 
metal, and the name is no more derived from anti 
and monachus than it is from anti and monos (op 
posed to single existence), another fictitious deriva 
tion that has been suggested, and one whose etymo 
logical value is supposed to consist in the fact that 
antimony is practically never found alone in nature. 

Notwithstanding the apparent cloud of unfounded 
traditions that are associated with his name, there 

1 It is curious to trace how old are the traditions on which some of 
these old stories, that must now be rejected, are founded. I have come 
upon the story with regard to Basil Valentine and the antimony and 
the monks in an old French medical encyclopedia of biography, published 
in the seventeenth century, and at that time there was no doubt at all 
expressed as to its truth. How much older than this it may be I do not 
know, though it is probable that it comes from the sixteenth century, 
when the kakotthes scribendi attacked many people because of the facil 
ity of printing, and when most of the good stories that have so worried 
the modern dry-as-dust historian in his researches for their correction 
became a part of the body of supposed historical tradition. It is prob 
ably French in origin because in that language antimoine is a tempting 
bait for that pseudo-philology which has so often led to false derivations. 


can be no doubt at all of the fact that Valentinus 
to give him the Latin name by which he is commonly 
designated in foreign literatures was one of the 
great geniuses, who, working in obscurity, make 
precious steps into the unknown that enable human 
ity after them to see things more clearly than ever 
before. There are definite historical grounds for 
placing Basil Valentine as the first of the series of 
careful observers who differentiated chemistry from 
the old alchemy and applied its precious treasures 
of information to the uses of medicine. It is said 
to have been because of the study of Basil Valen 
tine s work that Paracelsus broke away from the 
Galenic traditions, so supreme in medicine up to his 
time, and began our modern pharmaceutics. Fol 
lowing Paracelsus came Van Helmont, the father 
of modern medical chemistry, and these three did 
more than any others to enlarge the scope of medica 
tion and to make observation rather than authority 
the most important criterion of truth in medicine. 
Indeed, the work of this trio of men of the fifteenth 
and sixteenth centuries the Renaissance in medi 
cine as in art dominated medical treatment, or at 
least the department of pharmaceutics, down almost 
to our own day, and their influence is still felt in 

While we do not know the absolute data of either 
the birth or the death of Basil Valentine and are 
not sure of the exact period even in which he lived 
and did his work, we are sure that a great original 
observer about the time of the invention of printing 
studied mercury and sulphur and various salts of 
the metals, and above all introduced antimony to 


the notice of the scientific world, and especially to 
the favor of practitioners of medicine. His book, 
" The Triumphal Chariot of Antimony," is full of 
conclusions not quite justified by his premises nor 
by his observations. There is no doubt, however, 
that the observational method which he employed 
furnished an immense amount of knowledge, and 
formed the basis of the method of investigation by 
which the chemical side of medicine was to develop 
during the next two or three centuries. Great harm 
was done by the abuse of antimony, but then great 
harm is done by the abuse of anything, no matter 
how good it may be. For a time it came to be the 
most important drug in medicine and was only re 
placed by venesection. 

The fact of the matter is that doctors were looking 
for effects from their drugs, and antimony is, above 
all things, effective. Patients, too, wished to see the 
effect of the medicines they took. They do so even 
yet, and when antimony was administered there was 
no doubt about its working. 

The most interesting of Basil Valentine s books, 
and the one which has had the most enduring in 
fluence, is undoubtedly " The Triumphal Chariot 
of Antimony." 1 It has been translated and has 

1 There is in the New York Academy of Medicine a thick 24mo 
volume in which three of the classics of older medicine are bound 
together. They are Kerckringius s " Commentary on the Triumphal 
Chariot of Antimony," published at Amsterdam, 1671; Steno s 
" Dissertation on the Anatomy of the Brain," published in Leyden 
in 1671, and Father Kircher s " Scrutinium Physico Contagiosae 
Luis quae dicitur Pestis " (Physico-medical Discussions of the Con 
tagious Disease which is called Pest). This was published at Leipzig 
in 1659. Just how the three works came to be bound together is hard 


had a wide vogue in every language of modern 
Europe. Its recommendation of antimony had such 
an effect upon medical practice that it continued 
to be the most important drug in the pharmacopeia 
down almost to the middle of the nineteenth century. 
If any proof were needed that Basil Valentine or 
that the author of the books that go under the name 
was a monk it would be found in the introduction 
to this volume, which not only states that fact very 
clearly, but also in doing so makes use of language 
that shows the writer to have been deeply imbued 
with the old monastic spirit. I quote the first para 
graph of this introduction because it emphasizes this. 
The quotation is taken from the English translation 
of the work as published in London in 1678. Curi 
ously enough, seeing the obscurity surrounding Val 
entine himself, we do not know for sure who made 
the translation. The translator apologizes some 
what for the deeply religious spirit of the book, 
but considers that he was not justified in eliminating 

to say. Very probably they belonged to some old-time scholar, though 
there is nothing about the books to tell anything of the story. The 
fact that all three of the authors were ecclesiastics of the Catholic 
Church, Valentine a Monk, Steno a Bishop, and Kircher a Jesuit, 
would seem to be one common bond and perhaps a reason for the 
binding of these rather disparate treatises together. In that case 
it is probable that the book came from an old monastic library 
dispersed after the suppression of the order by some government. 
It seems not unlikely that the volume belonged at some time to an 
old Jesuit library, for they have suffered the most in that way. 
That these three classics of medicine should have been republished 
in handy volume editions within practically ten years shows an 
interest in medical literature that has not existed again until our 
own time, for during the eighteenth and early nineteenth centuries 
there was almost utter neglect of them. 


any of this. The paragraph is left in the quaint, 
old-fashioned form so eminently suited to the 
thoughts of the old master, and the spelling and 
use of capitals is not changed. 

"Basil Valentine: His Triumphant Chariot of 
Antimony. Since I, Basil Valentine, by Religious 
Vows am bound to live according to the order of St. 
Benedict and that requires another manner of Spirit 
of Holiness than the common state of Mortals exer 
cised in the profane business of this World; I 
thought it my duty before all things, in the beginning 
of this little book, to declare what is necessary to be 
known by the pious Spagyrist [old-time name for 
medical chemist], inflamed with an ardent desire of 
this Art, as what he ought to do, and whereunto to 
direct his striving, that he may lay such foundations 
of the whole matter as may be stable ; lest his Build 
ing, shaken with the Winds, happen to fall, and the 
whole Edifice to be involved in shameful Ruine 
which otherwise being founded on more firm and 
solid principles, might have continued for a long 
series of time. "Which Admonition I judged was, 
is and always will be a necessary part of niy re 
ligious Office; especially since we must all die, and 
no one of us which are now, whether high or low, 
shall long be seen among the number of men. For 
it concerns me to recommend these Meditations of 
Mortality to Posterity, leaving them behind me, not 
only that honor may be given to the Divine Majesty, 
but also that men may obey him sincerely in all 

" In this my meditation I found that there were 
five principal heads, chiefly to be considered by the 
wise and prudent spectators of our Wisdom and 
Art. The first of which is Invocation of God. The 
second, Contemplation of Nature. The third, True 
Preparation. The fourth, the Way of Using. The 


fifth, Utility and Fruit. For he who regards not 
these, shall never obtain place among true Chymists, 
or fill up the number of perfect Spagyrists. There 
fore, touching these five heads, we shall here follow 
ing treat and so far declare them, as that the general 
"Work may be brought to light and perfected by an 
intent and studious Operator." 

This book, though the title might seem to indicate 
it, is not devoted entirely to the study of antimony, 
but contains many important additions to the chem 
istry of the time. For instance, Basil Valentine ex 
plains in this work how what he calls the spirit of 
salt might be obtained. He succeeded in manufac 
turing this material by treating common salt with 
oil of vitriol and heat. From the description of 
the uses to which he put the end product of his 
chemical manipulation, it is evident that under the 
name of spirit of salt he is describing what we now 
know as hydrochloric acid. This is said to be the 
first definite mention of it in the history of science, 
and the method suggested for its preparation is not 
very different from that employed even at the pres 
ent time. He also suggests in his volume how alco 
hol may be obtained in high strengths. He distilled 
the spirit obtained from wine over carbonate of 
potassium, and thus succeeded in depriving it of a 
great proportion of its water. "We have said that 
he was deeply interested in the philosopher s stone. 
Naturally this turned his attention to the study of 
metals, and so it is not surprising to find that he 
succeeded in formulating a method by which metallic 
copper could be obtained. The material used for the 
purpose was copper pyrites, which was changed to 


an impure sulphate of copper by the action of oil 
of vitriol and moist air. The sulphate of copper 
occurred in solution, and the copper could be pre 
cipitated from it by plunging an iron bar into it. 
Basil Valentine recognized the presence of this 
peculiar yellow metal, and studied some of its quali 
ties. He does not seem to have been quite sure, 
however, whether the phenomenon that he witnessed 
was not really a transmutation of at least some of 
the iron into copper as a consequence of the other 
chemicals present. There are some observations on 
chemical physiology, and especially with regard to 
respiration, in the book on antimony which show 
their author to have anticipated the true explanation 
of the theory of respiration. He states that animals 
breathe because air is needed to support their life, 
and that all the animals exhibit the phenomenon of 
respiration. He even insists that the fishes, though 
living in water, breathe air, and he adduces in sup 
port of this idea the fact that whenever a river is 
entirely frozen the fishes die. The reason for this 
being, according to this old-time physiological chem 
ist, not that the fishes are frozen to death, but that 
they are not able to obtain air in the ice as they 
did in the water, and consequently perish. 

There are many testimonials to the practical char 
acter of all his knowledge and his desire to apply 
it for the benefit of humanity. The old monk could 
not repress the expression of his impatience with 
physicians who gave to patients for " diseases of 
which they knew little, remedies of which they knew 
less." For him it was an unpardonable sin for a 
physician not to have faithfully studied the various 


mixtures that he prescribed for his patients, and not 
to know not only their appearance and taste and 
effect, but also the limits of their application. Con 
sidering that at the present time it is a frequent 
source of complaint that physicians often prescribe 
remedies with even whose physical appearance they 
are not familiar and whose composition is often quite 
unknown to them, this complaint of the old-time 
chemist alchemist will be all the more interesting 
for the modern physician. It is evident that when 
Basil Valentine allows his ire to get the better of 
him it is because of his indignation over the quacks 
who were abusing medicine and patients in his time, 
as they have ever since. There is a curious bit of 
aspersion on mere book learning in the passage that 
has a distinctly modern ring, and one feels the truth 
of Russell Lowell s expression that to read a classic, 
no matter how antique, is like reading a commentary 
on the morning paper, so up-to-date does genius ever 
remain : 

" And whensoever I shall have occasion to contend 
in the School with such a Doctor, who knows not 
how himself to prepare his own medicines, but com 
mits that business to another, I am sure I shall ob 
tain the Palm from him ; For indeed that good man 
knows not what medicines he prescribes to the sick ; 
whether the color of them be white, black, gray, or 
blew (sic), he cannot tell; nor doth this wretched 
man know whether the medicine he gives be dry or 
hot, cold or humid ; but he only knows that he found 
it so written in his books, and then pretends to 
knowledge or as it were Possession by Prescription 
of a very long time; yet he desires to further in 
formation. Here again let it be lawful to exclaim, 
Good God, to what a state is the matter brought! 


what Goodness of Minde is in these men ! what care 
do they take of the sick! Wo, wo to them! in the 
day of Judgement they will find the fruit of their 
Ignorance and Rashness, then they will see him 
whom they pierced, when they neglected their Neigh 
bor, sought after money and nothing else ; whereas 
were they cordial in their profession, they would 
spend Nights and Days in Labour that they might 
become more learned in their Art, whence more cer 
tain health would accrew to the sick with their esti 
mation and greater glory to themselves. But since 
Labour is tedious to them they commit the matter 
to chance, and being secure of their Honour, and 
content with their Fame, they (like Brawlers) de 
fend themselves with a certain garrulity, without 
any respect had to Confidence or Truth." 

Perhaps one of the reasons why Valentine s book 
has been of such enduring interest is that it is 
written in an eminently human vein and out of a 
lively imagination. It is full of figures relating to 
many other things besides chemistry, which serve to 
show how deeply this investigating observer was 
attentive to all the problems of life around him. 
For instance, when he wants to describe the affinity 
that exists between many substances in chemistry, 
and which makes it impossible for them not to be 
attracted to one another, he takes a figure from the 
attractions that he sees exist among men and women. 
It is curious to find affinities discussed in our modern 
sense so long ago. There are some paragraphs with 
regard to the influence of the passion of love that 
one might think rather a quotation from an old-time 
sermon than from a great ground-breaking book in 
the science of chemistry. 


" Love leaves nothing entire or sound in man; it 
impedes his sleep, he cannot rest either day or night ; 
it takes off his appetite that he hath no disposition 
either to meat or drink by reason of the continual 
torments of his heart and mind. It deprives him of 
all Providence, hence he neglects his affairs, voca 
tion, and business. He minds neither study, labor, 
nor prayer ; casts away all thoughts of anything but 
the body beloved; this is his study, this his most 
vain occupation. If to lovers the success be not an 
swerable to their wish, or so soon and prosperously 
as they desire, how many melancholies henceforth 
arise, with griefs and sadness, with which they pine 
away and wax so lean as they have scarcely any flesh 
cleaving to the bones. Yea, at last they lose the life 
itself, as may be proved by many examples ! for such 
men (which is an horrible thing to think of) slight 
and neglect all perils and detriments, both of the 
body and life, and of the soul and eternal salvation." 

It is evident that human nature is not different 
in our sophisticated twentieth century from that 
which this observant old monk saw around him in 
the fifteenth. He continues: 

" How many testimonies of this violence which is 
in love, are daily found? for it not only inflames the 
younger sort, but it so far exaggerates some persons 
far gone in years as through the burning heat 
thereof, they are almost mad. Natural diseases are 
for the most part governed by the complexion of 
man and therefore invade some more fiercely, others 
more gently; but Love, without distinction of j30or 
or rich, young or old, seizeth all, and having seized 
so blinds them as forgetting all rules of reason, they 
neither see nor hear any snare." 

But then the old monk thinks that he has said 
enough about this rather foreign subject, and apolo- 


gizes for his digression in another paragraph that 
should remove any lingering doubt there might be 
with regard to the genuineness of his monastic char 
acter. At the end of the passage he makes the 
application in a very few words. The personal ele 
ment in his confession is so nai ve and so simply 
straightforward that instead of seeming to be the 
result of conceit, which would surely have repelled 
the reader, it rather attracts and enhances his kindly 
feeling for its author. The paragraph would remind 
one in certain ways of that personal element that 
was to become more popular in literature after 
Montaigne in the next century made it rather the 

" But of these enough; for it becomes not a re 
ligious man to insist too long upon these cogitations, 
or to give place to such a flame in his heart. Hith 
erto (without boasting I speak it) I have throughout 
the whole course of my life kept myself safe and free 
from it, and I pray and invoke God to vouchsafe 
me his Grace that I may keep holy and inviolate the 
faith which I have sworn, and live contented with 
my spiritual spouse, the Holy Catholick Church. 
For no other reason have I alleged these than that 
I might express the love with which all tinctures 
ought to be moved towards metals, if ever they be 
admitted by them into true friendship, and by love, 
which permeates the inmost parts, be converted into 
a better state." 

The application of the figure at the end of his 
long digression is characteristic of the period in 
which he wrote, as also to a considerable extent 
of the German literary methods of the time. 

In this volume on the use of antimony there are 


in most of the editions certain biographical notes 
which have sometimes been accepted as authentic, 
but oftener rejected. According to these, Basil Val 
entine was born in a town in Alsace, on the southern 
bank of the Rhine. As a consequence of this, there 
are several towns that have laid claim to being his 
birthplace. M. Jean Eeynaud, the distinguished 
French philosophical writer of the first half of the 
nineteenth century, once said that Basil Valentine, 
like Ossian and Homer, had many towns claim him 
years after his death. He also suggested that, like 
those old poets, it was possible that the writings 
sometimes attributed to Basil Valentine were really 
the work not of one man, but of several individuals. 
There are, however, many objections to this theory, 
the most forcible of which is the internal evidence 
derived from the books themselves showing similari 
ties of style and method of treating subjects too great 
for us to admit non-identity in the writers. M. 
Reynaud lived at a time when it was all the fashion 
to suggest that old works that had come down to 
us, like the Iliad and the Odyssey, and even such 
national epics as the Cid and the Arthur Legends 
and the Nibelungenlied were to be attributed to 
several writers rather than to one. We have passed 
that period of criticism, however, and have reverted 
to the idea of single authorship for these works, and 
the same conclusion has been generally come to with 
regard to the writings attributed to Basil Valentine. 
Other biographic details contained in " The Tri 
umphal Chariot of Antimony are undoubtedly 
more correct. According to them Basil Valentine 
travelled in England and Holland on missions for his 


order, and went through France and Spain on a 
pilgrimage to St. James of Compostella. 

Besides this work, there is a number of other 
books of Basil Valentine s, printed during the first 
half of the sixteenth century, that are well known 
and copies of which may be found in most of the 
important libraries. The United States Surgeon 
General s Library at Washington contains not a few 
of the works on medical subjects, and the New York 
Academy of Medicine Library has some valuable 
editions of certain of his works. Some of his other 
well-known books, each of which is a good-sized 
octavo volume, bear the following descriptive titles 
(I give them in English, though as they are usually 
found, they are in Latin, sixteenth-century transla 
tions of the original German) : " The World in Mini 
ature . or, The Mystery of the World and of Human 
Medical Science," published at Mayburg, 1609; 
" The Chemical Apocalypse: or, The Manifestation 
of Artificial Chemical Compounds," published in 
Erfurt in 1624; " A Chemico-Philosophic Treatise 
Concerning Things Natural and Preternatural, Es 
pecially Kelating to the Metals and the Minerals," 
published at Frankfurt in 1676; " Haliography: or, 
The Science of Salts : A Treatise on the Preparation, 
Use, and Chemical Properties of All the Mineral, 
Animal, and Vegetable Salts," published at Bologna 
in 16-14 ; The Twelve Keys of Philosophy, Leipsic, 
1630. These are of interest to the chemist and 
physicist rather than to the physician, and it is as 
a Maker of Medicine that we are concerned with 
Valentine here. 

The great attention aroused in Basil Valentine s 


work at the Eenaissance period can be best realized 
from the number of manuscript copies and their 
wide distribution. His books were not all printed 
at one place, but, on the contrary, in different por 
tions of Europe. The original edition of " The 
Triumphal Chariot of Antimony " was published in 
Leipsic in the early part of the sixteenth century. 
The first editions of the other books, however, ap 
peared at places so distant from Leipsic as Am 
sterdam and Bologna, while various cities of Ger 
many, as Erfurt and Frankfurt, claim the original 
editions of still other works. Many of the manu 
script copies still exist in various libraries in Eu 
rope; and while there is no doubt that some unim 
portant additions to the supposed works of Basil 
Valentine have come from the attribution to him of 
scientific treatises of other German writers, the style 
and the method of the principal works mentioned is 
entirely too similar not to have been the fruit of 
a single mind and that possessed of a distinct in 
vestigating genius, setting it far above any of its 
contemporaries in scientific speculation and observa 

The most interesting feature of all of Basil Valen 
tine s writings that are extant is the distinctive ten 
dency to make his observations of special practical 
utility. His studies in antimony were made mainly 
with the idea of showing how that substance might 
be used in medicine. He did not neglect to point 
out other possible uses, however, and knew the secret 
of the employment of antimony in order to give 
sharpness and definition to the impression produced 
by metal types. It would seem as though he was 


the first scientist who discussed this subject, and 
there is even some question of whether printers and 
typefounders did not derive their ideas in this mat 
ter from our chemist. 

Interested though he was in the transmutation of 
metals, he never failed to try to find and suggest 
some medicinal use for all of the substances that 
he investigated. His was no greedy search for gold 
and no cumulation of investigations with the idea 
of benefiting only himself. Mankind was always in 
his mind, and perhaps there is no better demonstra 
tion of his fulfilment of the character of the monk 
than this constant solicitude to benefit others by 
every bit of investigation that he carried out. For 
him, with medieval nobleness of spirit, " the first 
part of every work must be the invocation of God, 
and the last, though no less important than the 
first, must be the utility and fruit for mankind that 
can be derived from it." 

The career of the last of the Makers of Medicine 
in the Middle Ages may be summed up briefly in 
a few sentences that show how thoroughly this old 
Benedictine was possessed of the spirit of modern 
science. He believed in observation as the most 
important source of medical knowledge. He valued 
clinical experience far above book information. He 
insisted on personal acquaintanceship on the part 
of the physician with the drugs he used, and thought 
nothing more unworthy of a practitioner of medicine, 
indeed he sets it down as almost criminal than 
to give remedies of whose composition he was not 
well aware and whose effect he did not thoroughly 
understand. He thought that nature was the most 


important aid to the physician, much more impor 
tant than drugs, though he was the first to realize 
the significance of chemical affinities, and he seems 
to have understood rather well how individual often 
were the effects obtained from drugs. He was a 
patient student, a faithful observer, a writer who 
did not begrudge time and care to the composition 
of large books on medicine, yet withal he was no 
dry-as-dust scholar, but eminently human in his 
sympathies with ailing humanity, and a strenuous 
upholder of the dignity of the profession to which 
he belonged. Scarcely more can be said of anyone 
in the history of medicine, at least so far as good 
intentions go ; though many accomplished more, none 
deserve more honor than the Thuringian monk whom 
we know as Basil Valentine. 

There are many other of these old-time Makers of 
Medicine of whom nearly the same thing can be said. 
Basil Valentine is only one of a number of men 
who worked faithfully and did much both for med 
ical science and professional life during the thou 
sand years from the fall of Rome to the fall of 
Constantinople, when, according to what used to be 
commonly accepted opinion, men were not animated 
by the spirit of research and of fine incentive to 
do good to men that we are so likely to think of 
as belonging exclusively to more modern times. A 
man whom he greatly influenced, Paracelsus, took 
up the tradition of scientific investigation where 
Basil Valentine had left it. His work, though more 
successfully revolutionary, was not done in such a 
fine spirit of sympathy with humanity nor with that 
simplicity of life and purity of intention that char- 


acterized the old monk s work. Paracelsus birth in 
the year of the discovery of America places him 
among the makers of the foundations of our modern 
medicine, and he will be treated of in a volume on 
The Forefathers in Medicine. 


In the midst of what has been called the " higher 
criticism " of the Bible in recent times, one of the 
long accepted traditions that has been most strenu 
ously assailed and, indeed, in the minds of many 
scholars, seemed, for a time at least, quite discred 
ited, was that St. Luke the Evangelist, the author 
of the Third Gospel and the Acts of the Apostles, 
was a physician. Distinguished authorities in early 
Christian apologetics have declared that the pillars 
of primitive Christian history are the genuine 
Epistles of St. Paul, the writings of St. Luke, and 
the history of Eusebius. It is quite easy to under 
stand, then, that the attack upon the authenticity of 
the writings usually assigned to St. Luke, which in 
many minds seemed successful, has been considered 
of great importance. In the very recent time there 
has been a decided reaction in this matter. This 
has come, not so much from Roman Catholics, who 
have always clung to the traditional view, and whose 
great Biblical students have been foremost in the 
support of the previously accepted opinion, but from 
some of the most strenuous of the German higher 
critics, who now appreciate that destructive, so- 
called higher criticism went too far, and that the 
traditional view not only can be maintained, but is 
the only opinion that will adequately respond to all 
the new facts that have been found, and all the re 
cently gathered information with regard to the re 
lations of events in the olden time. 

1 Paper read before the first meeting of the American Guild of St. 



By far the most important contribution to the dis 
cussion in recent years came not long since from the 
pen of Professor Adolph Harnack, the professor of 
church history in the University of Berlin. Pro 
fessor Harnack & name is usually cited as that of 
one of the most destructive of the higher critics. 
His recent book, however, " Luke the Physician," 1 is 
an entire submission to the old-fashioned viewpoint 
that the writer of the Third Gospel and of the Acts 
of the Apostles was a Greek fellow-worker of St. 
Paul, who had been in company for years with 
Mark and Philip and James, and who had previ 
ously been a physician, and was evidently well 
versed in all the medical lore of that time. Har 
nack does cot merely concede the old position. As 
might be expected, his rediscussion of the subject 
clinches the arguments for the traditional view, and 
makes it impossible ever to call it in question again. 
It is easy to understand how important are such ad 
missions when we recall how much this traditional 
view has been assailed, and how those who have held 
it have been accused of old-fogyism and lack of 
scholarship, and unwarranted clinging to antiquated 
notions just because they thought they were of faith, 
and how, lacking in true scholarship, seriously ham 
pering genuine investigation, such conservatism has 
been declared to be. 

The question of Luke s having been a physician is 
an extremely valuable one, and no one in our time is 
better fitted by early training and long years of 
study to elucidate it than Professor Harnack. He be 
gan his excursions into historical writing years ago, 
as I understand, as an historian of early Christian 
medicine. Some of his works on medical conditions 
just before and after Christ are quoted confidently 
by the distinguished German medical historians. 
From this department he graduated into the field 

1 Published by Putnams, New York, 1909. 


of the higher criticism. He is eminently in a posi 
tion, therefore, to state the case with regard to St. 
Luke fully, and to indicate absolutely the conclu 
sions that should be drawn from the premises of 
fact, writings, and traditions that we have. He does 
so in a very striking way. Perhaps no better ex 
ample of his thoroughly lucid and eminently logical 
mode of argumentation is to be found than the para 
graph in which he states the question. It might well 
be recommended as an example of terse forcefulness 
and logical sequence that deserves the emulation of 
all those who want to write on medical subjects. If 
we had more of these characteristic qualities of Har- 
nack s style, our medical literature, so called, would 
not need to occupy so many pages of print as it 
does yet would say more. Here it is : 

St. Luke, according to St. Paul, was a physician. When a physician 
writes a historical work it does not necessarily follow that his profession 
shows itself in his writing ; yet it is only natural for one to look for traces 
of the author s medical profession in such a -work. These traces may be 
of different kinds: 1, The whole character of the narrative may be deter 
mined by points of view, aims, and ideals which are more or kss medical 
(disease and its treatment); 2, marked preference may be shown for 
stories concerning the healing of diseases, which stories may be given in 
great number and detail; 3, the language may be colored by the lan 
guage of physicians (medical technical terms, metaphors of medical char 
acter, etc.). All these three groups of characteristic signs are found, as 
we shall see, in the historical work which bears the name of St. Luke. 
Here, however, it may be objected that the subject matter itself is 
responsible for these traits, so that their evidence is not decisive for the 
medical calling of the author. Jesus appeared as a great physician and 
healer. All the evangelists say this of Him; hence it is not surprising 
that one of them has set this phase of His ministry in the foreground, and 
has regarded it as the most important. Our evangelist need not there 
fore have been a physician, especially if he were a Greek, seeing that in 
those days Greeks with religious interests were disposed to regard 
religion mainly under the category of healing and salvation. This is 
true, yet such a combination of characteristic signs will compel us to 
believe that the author was a physician if, 4, the description of the par 
ticular cases of disease shows distinct traces of medical diagnosis and 
scientific knowledge; 5, if the language, even where questions of medi 
cine or of healing are not touched upon, is colored by medical phrase 
ology; and, 6, if in those passages where the author speaks as an eye 
witness medical traits are especially and prominently apparent. These 
three kinds of tokens are also found in the historical work of our 
author. It is accordingly proved that it proceeds from the pen of a 


The importance of the concession that Luke was a 
physician should be properly appreciated. His 
whole gospel is written from that standpoint. For 
him the Saviour was the healer, the good physician 
who went about curing the ills of the body, while 
ministering to people s souls. He has more ac 
counts of miracles of healing than any of the other 
Evangelists. He has taken certain of the stories 
of the other Evangelists who were eye-witnesses, 
and when they were told in naive and popular lan 
guage that obscured the real condition that was 
present, he has retold the story from the physician s 
standpoint, and thus the miracle becomes clearer 
than ever. In one case, where Mark has a slur on 
physicians, Luke eliminates it. In a number of 
cases the correction of Mark s popular language in 
the description of ailments is made in terms that 
could not have been used except by one thoroughly 
versed in the Greek medical terminology of the 
times. As a matter of fact, there seems to be no 
doubt now that Luke had been, before he became an 
Evangelist, a practising physician in Malta of con 
siderable experience. His testimony, then, to the 
miracles is particularly valuable as almost a medical 

In medical science, St. Luke s time was by no 
means barren of knowledge. The Alexandrian 
school of medicine had done some fine work in its 
time. It was the first university medical school in 
the world s history, and there dissection was first 
practised regularly and publicly for the sake of 
anatomy, and even the vivisection of criminals who 
were supplied by the Ptolemei for human physi 
ology, was a part of the school curriculum. A num 
ber of important discoveries in brain anatomy are 
attributed to Herophilus, after whom the torcular 
herophili within the skull is named, and who in 
vented the term calamus scriptorius for certain ap- 


pearances in the fourth ventricle. His colleague, 
Erasistratus, the co-founder of this school at Alex 
andria, did work in pathological anatomy, and laid 
the foundation for serious study there. For three 
centuries there is some good worker, at or in con 
nection with Alexandria, whose name is preserved 
for us in the history of medicine. Other Greek 
schools of medicine in the East, as, for instance, that 
of Pergamos, also did excellent work. Galen is the 
great representative of this school, and he came in 
the century after St. Luke. A physician educated 
in Greek medicine at that time, then, would be in 
an excellent position to judge critically of the 
miracles of healing of the Christ, and it would seem 
to have been providential that Luke was called for 
this purpose. 

The evidence for his membership of our pro 
fession will doubtless be interesting to all physi 
cians. Some of the distinctive passages in which 
Luke s familiarity with medical terms to such an 
extent that to express his meaning he found him 
self compelled to use them, will appeal at once to 
these, for whom such terms are part of everyday 
speech. The use of the word hydropikos, which is 
not to be met with anywhere else in the New Testa 
ment, nor in the non-medical Greek literature of that 
time, though the word is of frequent occurrence as a 
designation for a person suffering from dropsy (and 
always, as in Luke, the adjective for the substan 
tive), in Hippocrates, Dioscorides, and Galen is a 
typical example. 

Where such vague terms as paralyzed occur 
Luke does not use the familiar word, but the med 
ical term that meant stricken with paralysis, in 
dicating not any inability to use the limbs, but such 
a one as was due to a stroke of apoplexy. "We who, 
as physicians, have heard of so many cures of 
paralysis from our friends, the Eddyites, are prone 


to ask, as the first question, what sort of a paralysis 
it was. Luke made inquiries from men who were 
eye-witnesses, and then has described the scene with 
such details as convinced him as a physician of the 
reality of the miracle, and his description was meant 
to carry conviction to the minds of others. 

Occasionally St. Luke uses words which only a 
physician would be likely to know at all. That is 
to say, even a man reasonably familiar with medical 
terminology and medical literature would not be 
likely to know them unless he had been technically 
trained. One of these is the word spliudron, a word 
which is only medical, and is not to be found even 
in such large Greek lexicons of ordinary words as 
that of Passow. Sphudron is the anatomical term 
of the Graeco-Alexandrian school for the condyles 
of the femur. Galen and other medical authors use 
it, and Luke, in giving the details of the story of 
the lame man cured, in the third chapter of the Acts, 
seventh verse, selects it because it exactly expresses 
the meaning he wished to convey. In this story 
there are a number of added medical details. These 
are all evidently arranged so as to give the full 
medical significance to the miracle. For instance, 
the man had been lame from birth, literally from 
the ii omb of his mother. At this time he was forty 
years of age, an age at which the spontaneous cure 
of such an ailment or, indeed, any cure of it, could 
scarcely be expected, if, during the preceding time, 
there had been no improvement. 

In the story of the cure of Saul s blindness Luke 
says in the Acts that his blindness fell from him 
like scales. The figure is a typically medical one. 
The word for fall that is used is, as was pointed out 
by Hobart (" Medical Language of St. Luke," Dub 
lin, 1882), exactly the term that is used for the fall 
ing of scales from the body. The term for scales is 
the specific designation of the particles that fall 


from the body during certain skin diseases or after 
certain of the infectious fevers, as in scarlet fever. 
Hippocrates and Galen have used it in many places. 
It is distinctively a medical word. In the story 
of the vision of St. Peter, told also in the Acts, the 
word ecsta-sis, from which we derive our word ec 
stasy, is used. This is the only word St. Luke uses 
for vision and he alone uses it. This term is of 
constant employment in a technical sense in the 
medical writers of St. Luke s time and before it. 
When the other evangelists talk of lame people they 
use the popular term. This might mean anything 
or nothing for a physician. Luke uses one of the 
terms that is employed by physicians when they wish 
to indicate that for some definite reason there is 
inability to walk. 

In the story of the Good Samaritan there are 
some interesting details that indicate medical inter 
est on the part of the writer. It is Luke s character 
istic story and a typical medical instance. He em 
ploys certain words in it that are used only by 
medical writers. The use of oil and wine in the 
treatment of the wounds of the stranger traveller 
was at one time said to indicate that it could not 
have been a physician who wrote the story, since the 
ancients used oil for external applications in such 
cases but not wine. More careful search of the old 
masters of medicine, however, has shown that they 
used oil and wine not only internally but externally. 
Hippocrates, for instance, has a number of recom 
mendations of this combination for wounds. It is 
rather interesting to realize this, and especially the 
wine in addition to the oil, because wine contains 
enough alcohol to be rather satisfactorily antiseptic. 
There seems no doubt that wounds that had been 
bathed in wine and then had oil poured over them 
would be likely to do better than those which were 
treated in other ways. The wine would cleanse and 


at least inhibit bacterial growth. The subsequent 
covering with oil would serve to protect the wound 
to some degree from external contamination. 

Sometimes there is an application of medical 
terms to something extraneous from medicine that 
makes the phrase employed quite amusing. For in 
stance, when Luke wants to explain how they 
strengthened the vessel in which they were to sail he 
describes the process by the term which was used in 
medical Greek to mean the splinting of a part or at 
least the binding of it up in such a way as to enable 
it to be used. The word was quite a puzzle to the 
commentators until it was pointed out that it was 
the familiar medical term, and then it was easy to 
understand. Occasionally this use of a medical 
term gives a strikingly accurate significance to 
Luke s diction. For instance, where other evangel 
ists talk of the Lord looking at a patient or turning 
to them, Luke uses the expression that was techni 
cally employed for a physician s examination of his 
patient, as if the Lord carefully looked over the ail 
ing people to see their physical needs, and then pro 
ceeded to cure them. Manifestly in Luke s mind the 
most interesting phase of the Lord s life was His 
exhibition of curative powers, and the Saviour was 
for him the divine healer, the God physician of bodies 
as well as of souls. 

There are many little incidents which he relates 
that emphasize this. For instance, where St. Mark 
talks about the healing of the man with a 
withered hand, St. Luke adds the characteristic 
medical note that it was the right hand. When he 
tells of the cutting off of the ear of the servant of 
the high priest in the Garden of Olives St. Luke takes 
the story from St. Mark, but adds the information 
that would appeal to a physician th#t it was the 
right ear. Moreover, though all four evangelists 
record the cutting off of the ear, only St. Luke adds 


the information that the Lord healed it again. It 
is as if he were defending the kindly feelings of the 
Divine Physician and as if it would have been in 
excusable had He not exerted His miraculous powers 
of healing on this occasion. It is St. Luke, too, who 
has constantly distinguished between natural ill 
nesses and cases of possession. This careful dis 
tinction alone would point to the author of the third 
gospel and the Acts as surely a physician. As it is 
it confirms beyond all doubt the claim that the 
writer of these portions of the New Testament was 
a physician thoroughly familiar with all the medical 
writings of the time and probably a physician who 
had practised for a long time. 

Certain miracles of healing are related only by 
St. Luke as if he realized better than any of the 
other evangelists the evidential value that such in 
stances would have for future generations as to the 
divinity of the personage who worked them. The 
beautiful story of the raising from death of the son 
of the widow of Nam is probably one of the oftenest 
quoted passages from St. Luke. It is a charming 
bit of literature. "While it suggests the writer physi 
cian it makes one almost sure that the other tradition 
according to which St. Luke was also a painter must 
be true. The scene is as picturesque as it can be. 
The Lord and His Apostles and the multitudes com 
ing to the gate of the little city just as in the evening 
sun the funeral cortege with the widow burying her 
only son came out of it. The approach of the Lord 
to the weeping mother, His command to the dead son 
to arise, and the simple words, " and he gave him 
back to his mother," constitute as charming a scene 
as a painter ever tried to visualize. Besides this, 
Luke alone has the story of the man suffering with 
dropsy and the woman suffering from weakness. 
The intensely picturesque quality of many of these 
scenes that he describes so vividly would indeed seem 


to place beyond all doubt the old tradition that he 
was an artist as well as a physician. 

It is interesting to realize that it is to Luke alone 
that we owe the account of the well-known message 
sent by Christ Himself to John the Baptist when 
John sent his disciples to inquire as to His mission. 
After describing His ministry He said: " Go and 
relate to John what you have heard and seen: the 
blind see, the lame walk, the deaf hear, the lepers 
are made clean, the dead rise again, to the poor 
the Gospel is preached." To no one more than to 
a physician would that description of His mission 
appeal as surely divine. 

To those who care to follow the subject still 
further, and above all, to read opinions given before 
the reversal of the verdict of the higher criticism 
on the Lucan writings, indeed before ever that trial 
was brought, there is much in " Horae Lucanre A 
Biography of St. Luke," by Henry Samuel Baynes 
(Longmans, 1870), that will surely be of interest. 
He has some interesting quotations which show how 
thoroughly previous centuries realized all the force 
of modern arguments. For instance, the following 
paragraph from Dr. Nathaniel Robinson, a Scotch 
physician of the eighteenth century, will illustrate 
this. Dr. Robinson said: 

It is manifest from his Gospel, that Luke was both an acute ob 
server, and had even given professional attention to all our Saviour s 
miracles of healing. Originally, among the Egyptians, divinity and 
physic were united in the same order of men, so that the priest had the 
cafe of souls, and was also the physician. It was much the same under 
the Jewish economy. But after physic came to be studied by the 
Greeks, they separated the two professions. That a physician should 
write the history of our Saviour s life was appropriate, as there were 
divers mysterious things to be noticed, concerning which his education 
enabled him to form a becoming judgment. 

It is even interesting to realize that St. Luke s 
tendency to use medical terms has been of definite 
value in determining the question whether both the 


third gospel and the Acts of the Apostles are by the 
same man. They have been attributed to St. Luke 
traditionally, but in the higher criticism some doubt 
has been thrown on this and an elaborate hypothe 
sis of dual authorship set up. It has been asserted 
that it is very improbable on extrinsic grounds that 
they were both written by one hand and certain in 
trinsic evidence, changes in the mode of narration, 
especially the use of the first personal pronoun in 
the plural in certain passages, has been pointed to 
as making against single authorship. This tendency 
to deny old-time traditions of authorship with re 
gard to many classical writings was a marked char 
acteristic of the early part of the nineteenth century, 
but the close of the century saw practically all of 
these denials discredited. The nineteenth century 
ushered in studies of Homer, with the separatist 
school perfectly confident in their assertion that the 
Iliad and the Odyssey were not by the same person, 
and even that the Iliad itself was the work of several 

At the beginning of the twentieth century we are 
quite as sure that both the Iliad and Odyssey were 
written by the same person and thit the separatists 
were hurried into a contrary decision not a little by 
the feeling of the sensation that such a contradiction 
of previously accepted ideas would create. This is 
a determining factor in many a supposed novel dis 
covery, that it is hard always to discount sufficiently. 
A thing may be right even though it is old, and most 
new discoveries, it must not be forgotten, that is, 
most of those announced with a great blare of trum 
pets, do not maintain themselves. The simple argu 
ment that the separatists would have to find another 
poet equal to Homer to write the other poem has 
done more than anything else to bring their opinion 
into disrepute. It is much easier to explain certain 
discrepancies, differences of style, and of treatment 


of subjects, as well as other minor variants, than to 
supply another great poet. Most of the works of 
our older literatures have gone through a similar 
trial during the over-hasty superficially critical nine 
teenth century. The Nibelungenlied has been at 
tributed to two or three writers instead of one. The 
Cid, the national epic of Spain, and the Arthur 
Legends, the first British epic, have been at least 
supposed to be amenable to the same sort of criti 
cism. In every case, scholars have gone back to 
the older traditional view of a single author. The 
phases of literary and historic criticism with regard 
to Luke s writings are, then, only a repetition of 
what all our great national classics have gone 
through from supercilious scholarship during the 
past hundred years. 

It is not surprising, then, that there should be dual 
or even triple ascriptions of authorship for various 
portions of the Scriptures, and Luke s writings have 
on this score suffered as much or more even than 
others, with the possible exception of Moses. It is 
now definitely settled, however, that the similarities 
of style between the Acts and the third gospel are 
too great for them to have come from two different 
minds. This is especially true, as pointed out by 
Harnack, in all that regards the use of medical terms. 
The writer of the Acts and the writer of the third 
gospel knew Greek from the standpoint of the phy 
sician of that time. Each used terms that we find 
nowhere else in Greek literature except among med 
ical writers. What is thus true for one critical at 
tack on Luke s reputation is also true in another 
phase of recent higher criticism. It has been said 
that certain portions of the Acts which are called 
the " we " portions because the narration changes 
in them from the third to the first person were to 
be attributed to another writer than the one who 
wrote the narrative portions. Here, once more, the 


test of the medical words employed has decided the 
case for Luke s sole authorship. It is evidently an 
excellent thing to be able to use medical terms prop 
erly if one wants to be recognized with certainty 
later on in history for just what one s business was. 
It has certainly saved the situation for St. Luke, 
though there may be some doubt as to the real force 
of objections thus easily overthrown. 

It is rather interesting to realize that many schol 
ars of the present generation had allowed themselves 
to be led away by the German higher criticism from 
the old tradition with regard to Luke as a physician 
and now will doubtless be led back to former views 
by the leader of German biblical critics. It shows 
how much more distant things may influence certain 
people than those nearer home how the hills are 
green far away. Harnack confesses that the best 
book ever written on the subject of Luke as a phy 
sician, the one that has proved of most value to 
him, and that he still recommends everyone to read, 
was originally written in English. It is Hobart s 
" Medical Language of St. Luke," l written more 
than a quarter of a century before Harnack. The 
Germans generally had rather despised what the 
English were doing in the matter of biblical criti 
cism, and above all in philology. Yet now the ac 
knowledged coryphaeus of them all, Harnack, not only 
admits the superiority of an old-time English book, 
but confesses that it is the best statement of the sub 
ject up to the present time, including his own. He 
constantly quotes from it, and it is evident that it 
has been the foundation of all of his arguments. It 
is not the first time that men have fetched from 
afar what they might have got just as well or better 
at home. 

Harnack has made complete the demonstration, 

i Dublin, 1882. 


then, that the third gospel and the Acts were writ 
ten by St. Luke, who had been a practising phy 
sician. In spite of this, however, he finds many ob 
jections to the Luke narratives and considers that 
they add very little that is valuable to the contem 
porary evidence that we have with regard to Christ. 
He impairs with one hand the value of what he has 
so lavishly yielded with the other. He finds incon 
sistencies and discrepancies in the narrative that for 
him destroy their value as testimony. A lawyer 
would probably say that this is that very human ele 
ment in the writings which demonstrates their au 
thenticity and adds to their value as evidence, be 
cause it shows clearly the lack of any attempt to do 
anything more than tell a direct story as it had 
come to the narrator. No special effort was made to 
avoid critical objections founded on details. It was 
the general impression that was looked for. 

Sir William Ramsay, in his " Luke the Phy 
sician and Other Studies in the History of Re 
ligion (New York: Armstrong and Sons, 1908), 
has answered Harnack from the side of the profes 
sional critic with much force. He appreciates thor 
oughly the value of Professor Harnack s book, and 
above all the reactionary tendency away from ni 
hilistic so-called higher criticism which characterized 
so much of German writing on biblical themes in 
the nineteenth century. He says (p. 7): "This 
[book of Harnack s] alone carries Lukan criticism 
a long step forwards, and sets it on a new and 
higher plane. Never has the unity and character of 
the book been demonstrated so convincingly and con 
clusively. The step is made and the plane is reached 
by the method which is practised in other depart 
ments of literary criticism, viz., by dispassionate in 
vestigation of the work and by discarding fashion 
able a priori theories." 

The distinguished English traveller and writer 


on biblical subjects points out, however, that 
in detail many of Harnack s objections to the 
Lukan narratives are due to insufficient considera 
tion of the circumstances in which they were written 
and the comparative significance of the details 
criticised. He says, " Harnack lays much stress on 
the fact that inconsistencies and inexactnesses occur 
all through Acts. Some of these are undeniable; 
and I have argued that they are to be regarded in 
the same light as similar phenomena in the poem 
of Lucretius and in other ancient classical writers, 
viz., as proofs that the work never received the final 
form which Luke intended to give it, but was still 
incomplete when he died. The evident need for a 
third book to complete the work, together with those 
blemishes in expression, form the proof." 

Ramsay s placing of Harnack s writing in general 
is interesting in this connection. (P. 8) " Professor 
Harnack stands on the border between the nineteenth 
and twentieth century. His book shows that he is to 
a certain degree sensitive of and obedient to the new 
spirit; but he is only partially so. The nineteenth 
century critical method was false, and is already 
antiquated. . . . 

The first century could find nothing real and true 
that was not accompanied by the marvellous and the 
supernatural. The nineteenth centnry could find 
nothing real and true that was. Which view was 
right and which was wrong? Was either complete 1 
Of these two questions, the second alone is profitable 
at the present. Both views were right in a certain 
way of contemplating; both views were wrong in 
a certain way. Neither was complete. At present, 
as we are struggling to throw off the fetters which 
impeded thought in the nineteenth century, it is 
most important to free ourselves from its prejudices 
and narrowness." 

He adds (pp. 26 and 27) : " There are clear signs 


of the unfinished state in which this chapter was left 
by Luke; but some of the German scholar s criti 
cisms show that he has not a right idea of the sim 
plicity of life and equipment that evidently char 
acterized the jailer s house and the prison. The 
details which he blames as inexact and inconsistent 
are sometimes most instructive about the circum 
stances of this provincial town and Eoman colonia. 

" But it is never safe to lay much stress on small 
points of inexactness or inconsistency in any author. 
One finds such faults even in the works of modern 
scholarship if one examines them in the microscopic 
fashion in which Luke is studied here. I think I can 
find them in the author [Harnack] himself. His 
point of view sometimes varies in a puzzling way." 

As a matter of fact, Harnack, as pointed out by 
Ramsay, was evidently working himself more and 
more out of the old conclusion as to the lack of au 
thenticity of the Lucan writings into an opinion 
ever more and more favorable to Luke. For instance, 
in a notice of his own book, published in the The- 
ologisclie Liter at urzeitung, " he speaks far more 
favorably about the trustworthiness and credibility 
of Luke, as being generally in a position to acquire 
and transmit reliable information, and as having 
proved himself able to take advantage of his posi 
tion. Harnack was gradually working his way to 
a new plane of thought. His later opinion is more 

Ramsay also points out that Professor Giffert, 
one of our American biblical critics, had felt com 
pelled by the geographical and historical evidence 
to abandon in part the older unfavorable criticism 
of Luke and to admit that the Acts is more trust 
worthy than previous critics allowed. Above all, 
" he saw that it was a living piece of literature 
written by one author." In a word, Luke is being 
vindicated in every regard. 


Some of the supposed inaccuracies of Luke vanish 
when careful investigation is made. Some of his 
natural history details, for instance, have been im 
pugned and the story of the viper that " fastened " 
itself upon St. Paul in Malta has been cited as an 
example of a story that would not have been told in 
that way by a man who knew medicine and the re 
lated sciences in Luke s time. Because the passage 
illustrates a number of phases of the discussion with 
regard to Luke s language I make a rather long 
quotation from Ramsay: 

Take a8 a specimen with which to finish off this paper the passage 
Acts xxviii, 9 et seq., which is very fully discussed by Harnack 
twice. He argues that the true meaning of the passage was not 
understood until medical language was compared, when it was shown 
that the Greek word by which the act of the viper to Paul s hand is 
described, implies "bit" and not merely "fastened upon." But it is 
a well-assured fact that the viper, a poisonous snake, only strikes, 
fixes the poison fangs on the flesh for a moment, and withdraws its 
head instantly. Its action could never be what is attributed by 
Luke the eye witness to this Maltese viper; that it hung from Paul s 
hand and was shaken off into the fire by him. On the other hand, 
constrictors, which have no poison fangs, cling in the way described, 
but as a rule do not bite. Are we, then, to understand in spite 
of the medical style and the authority of Professor Blass (who trans 
lates " momordit " in his edition), that the viper fastened upon the 
apostle s hand? Then, the very name viper is a difficulty. Was 
Luke mistaken about the kind of snake which he saw? A trained 
medical man in ancient times was usually a good authority about 
serpents, to which great respect was paid in ancient medicine and 

Mere verbal study is here utterly at fault. We can make no 
progress without turning to the realities and facts of Maltese natural 
history. A correspondent obligingly informed me some years ago 
that Mr. Bryan Hook, of Farnham, Surrey (who, my correspondent 
assures me, is a thoroughly good naturalist), had found in Malta 
a small snake, Coronella austriaca, which is rare in England, but 
common in many parts of Europe. It is a constrictor, without 
poison fangs, which would cling to the hand or arm as Luke de 
scribes. It ia similar in size to the viper, and so like in markings 
and general appearance that Mr. Hook, when he caught his specimen, 
thought he was killing a viper. 

My friend, Prof. J. W. H. Trail, of Aberdeen, whom I consulted, 
replied that Coronella Icevis or austriaca, is known in Sicily and the 
adjoining islands; but he can find no evidence of its existence in 
Malta. It is known to be rather irritable, and to fix its small teeth 
so firmly into the human skin as to need a little force to pull it off, 


though the teeth are too short to do any real injury to the skin. 
Coronella is at a glance very much like a viper; and in the flames 
it would not be closely examined. While it is not reported as found 
in Malta except by Mr. Hook, two species are known there belong 
ing to the same family and having similar habits (leopardinus and 
zamenis (or coluber) gcmonensis) . The coloring of Coronella leo- 
pardinus would be the most likely to suggest a viper. 

The observations justify Luke entirely. We have here a snake so 
closely resembling a viper as to be taken for one by a good naturalist 
until he had caught and examined a specimen. It clings, and yet it 
also bites without doing harm. That the Maltese rustics should mis 
take this harmless snake for a venomous one is not strange. Many un 
educated people have the idea that all snakes are poisonous in varying 
degrees, just as the vulgar often firmly believe that toads are poison 
ous. Every detail as related by Luke is natural, and in accordance 
with the facts of the country. 

In a word, then, the whole question as to Luke s 
authority as a writer, as an eye-witness of many 
things, and as the relator of many others with regard 
to which he had obtained the testimony of eye-wit 
nesses is fully vindicated. Twenty years ago many 
scholars were prone to doubt this whole question. 
Ten years ago most of them were convinced that the 
Luke traditions were not justified by recent investi 
gation. Now we have come back once more to the 
complete acceptance of the old traditions. 

Perhaps the most unfortunate characteristic of 
much nineteenth-century criticism in all depart 
ments, even those strictly scientific, was the marked 
tendency to reject previous opinions for new ones. 
Somehow men felt themselves so far ahead of old- 
time writers and thinkers that they concluded they 
must hold opinions different from their ancestors. 
In nearly every case the new ideas that they evolved 
by supposedly newer methods are not standing the 
test of time and further study. There had been a 
continuous belief in men s minds, having its basis 
very probably on a passage in one of St. Peter s 
Epistles, that the earth would dissolve by fire. This 
was openly contradicted all during the nineteenth 
century and the time when the earth would freeze 
up definitely calculated by our mathematicians. 


Now after having studied radioactivity and learned 
from the physicist that the earth is heating up and 
will eventually get too hot for life, we calmly go 
back to the old Petrine declaration. Some of the 
most distinguished of the German biologists of the 
present day, such men as Driesch and others, calmly 
tell us that the edifice erected by Darwin will have 
to come down because of newly discovered evidence, 
and indeed some of them go so far as to declare that 
Darwinism was a crude hypothesis very superficial 
in its philosophical aspects and therefore acceptable 
to a great many people who, because it was easy to 
understand and was very different from what our 
fathers had believed, hastened to accept it. Nothing 
shows the necessity for being conservative in the 
matter of new views in science or ethics or religion 
more than the curious transition state in which we 
are with regard to many opinions at the present 
time, with a distinct tendency toward reaction to 
older views that a few years ago were thought quite 
untenable. We are rather proud of the advance that 
we are supposed to be making along many lines in 
science and scholarship, and yet over and over again, 
after years of work, we prove to have been following 
a wrong lead and must come back to where we 
started. This has been the way of man from the be 
ginning and doubtless will continue. The present 
generation are having this curious regression that 
follows supposed progress strongly emphasized for 



With the growth of interest in science and in na 
ture study in our own day, one of the expressions 
that is probably oftenest heard is surprise that the 
men of preceding generations and especially uni 
versity men did not occupy themselves more with 
the world around them and with the phenomena that 
are so tempting to curiosity. Science is usually sup 
posed to be comparatively new and nature study only 
a few generations old. Men are supposed to have 
been so much interested in book knowledge and in 
speculations and theories of many kinds, that they 
neglected the realities of life around them while spin 
ning fine webs of theory. Previous generations, of 
course, have indulged in theory, but then our own 
generation is not entirely free from that amusing 
occupation. Nothing could well be less true, however, 
than that the men of preceding generations were not 
interested in science even in the sense of physical 
science, or that nature study is new, or that men 
were not curious and did not try to find out all they 
could about the phenomena of the world around 

The medieval universities and the school-men who 
taught in them have been particularly blamed for 
their failure to occupy themselves with realities in- 

J The material for this chapter was gathered for a paper read before the 
Medical Improvement Society of Boston in the spring of 1911. In 
nearly its present form it was published in The Popular Science Monthly 
for May, 1911, and thanks are returned to the editor of that magazine 
for permission to reprint it here. The additions that have been made 
refer particularly to the estimation of Aristotle in the Middle Ages. 



stead of with speculation. We are coming to recog 
nize their wonderful zeal for education, the large 
numbers of students they attracted, the enthusiasm 
of their students, since they made so many hand 
written copies of the books of their masters, the de 
votion of the teachers themselves, who wrote at 
much greater length than do our professors even 
now and on the most abstruse subjects, so that it is 
all the more surprising to think they should have 
neglected science. The thought of our generation in 
the matter, however, is founded entirely on an as 
sumption. Those who know anything about the 
writers of the Middle Ages at first hand are not 
likely to think of them as neglectful of science even 
in our sense of the term. Those who know them 
at second hand are, however, very sure in the matter. 
The assumption is due to the neglect of history 
that came in the seventeenth and eighteenth cen 
turies. We have many other similar assumptions 
because of the neglect of many phases of mental de 
velopment and applied science at this time. For in 
stance, most of us are very proud of our modern 
hospital development and think of this as a great 
humanitarian evolution of applied medical science. 
We are very likely to think that this is the first time 
in the world s history that the building of hospitals 
has been brought to such a climax of development, 
and that the houses for the ailing in the olden time 
were mere refuges, prone to become death traps and 
at most makeshifts for the solution of the problem 
of the care of the ailing poor. This is true for the 
hospitals of the seventeenth and eighteenth centuries, 
but it is not true at all for the hospitals of the thir 
teenth and fourteenth and fifteenth centuries. Miss 
Nutting and Miss Dock in their " History of Nurs 
ing 1 have called attention to the fact that the 
lowest period in hospital development is during the 

New York, Putnam, 1908. 


eighteenth and early nineteenth centuries. Hospi 
tals were little better than prisons, they had narrow- 
windows, were ill provided with light and air and 
hygienic arrangements, and in general were all that 
we should imagine old-time hospitals to be. The 
hospitals of the earlier time, however, had fine high 
ceilings, large windows, abundant light and air, ex 
cellent arrangements for the privacy of patients, and 
in general were as worthy of the architects of the 
earlier times as the municipal buildings, the cathe 
drals, the castles, the university buildings, and every 
other form of construction that the late medieval 
centuries devoted themselves to. 

The trouble with those who assume that there was 
no study of science and practically no attention to 
nature study in the Middle Ages is that they know 
nothing at all at first hand about the works of the 
men who wrote in the medieval period. They have 
accepted declarations with regard to the absolute de 
pendence of the scholastics on authority, their al 
most divine worship of Aristotle, their utter readi 
ness to accept authoritative assertions provided they 
came with the stamp of a mighty name, and then 
their complete lack of attention to observation and 
above all to experiment. Nothing could well be more 
ridiculous than this ignorant assumption of knowl 
edge with regard to the great teachers at the me 
dieval universities. Just as soon as there is definite 
knowledge of what these great teachers wrote and 
taught, not only does the previous mood of blame for 
them for not paying much more attention to science 
and nature at once disappear, but it gives place to 
the heartiest admiration for the work of these great 
thinkers. It is easy to appreciate, then, what Pro 
fessor Saintsbury said in a recent volume on the 
thirteenth century: 

And there have even been in these latter days some graceless ones 
who have asked whether the science of the nineteenth century after an 


equal interval will be of any more positive value whether it will 
not have even less comparative interest than that which appertains to 
the scholasticism of the thirteenth. 

Three men were the great teachers in the medieval 
universities at their prime. They have been read 
and studied with interest ever since. They wrote 
huge tomes, but men have pored over them in every 
generation. They were Albertus Magnus, the 
teacher of the other two, Thomas Aquinas and Roger 
Bacon. All three of them were together at the Uni 
versity of Paris shortly after the middle of the thir 
teenth century. Anyone who wants to know any 
thing about the attitude of mind of the medieval 
universities, their professors and students, and of all 
the intellectual world of the time towards science 
and observation and experiment, should read the 
books of these men. Any other mode of getting at 
any knowledge of the real significance of the science 
of this time is mere pretence. These constitute the 
documents behind any scientific history of the de 
velopment of science at this time. 

It is extremely interesting to see the attitude of 
these men with regard to authority. In Albert s 
tenth book (of his " Summa "), in which he cata 
logues and describes all the trees, plants, and herbs 
known in his time, he observes: " All that is here 
set down is the result of our own experience, or has 
been borrowed from authors whom we know to have 
written what their personal experience has con 
firmed; for in these matters experience alone can 
be of certainty." In his impressive Latin phrase 
" experimentum solum certificat in talibus." With 
regard to the study of nature in general he was quite 
as emphatic. He was a theologian as well as a sci 
entist, yet in his treatise on " The Heavens and 
the Earth " he declared that " in studying nature 
we have not to inquire how God the Creator may, as 
He freely wills, use His creatures to work miracles 


and thereby show forth His power. "We have rather 
to inquire what nature with its immanent causes can 
naturally bring to pass." 1 

Just as striking quotations on this subject might 
be made from Koger Bacon. Indeed, Bacon was 
quite impatient with the scholars around him who 
talked over-much, did not observe enough, depended 
to excess on authority, and in general did as mediocre 
scholars always do, made much fuss on second-hand 
information plus some filmy speculations of their 
own. Friar Bacon, however, had one great pupil 
whose work he thoroughly appreciated because it 
exhibited the opposite qualities. This was Petrus 
we have come to know him as Peregrinus whose 
observations on magnetism have excited so much at 
tention in recent years with the republications of 
his epistle on the subject. It is really a monograph 
on magnetism written in the thirteenth century. 
Roger Bacon s opinion of it and of its author fur 
nishes us the best possible index of his attitude of 
mind towards observation and experiment in science. 

I know of only one person who deserves praise for his work in ex 
perimental philosophy for he does not care for the discourses of men 
and their wordy warfare, but quietly and diligently pursues the works 
of wisdom. Therefore what others grope after blindly, as bats in the 
evening twilight, this man contemplates in their brilliancy because 
he is a master of experiment. Hence, he knows all of natural science 
whether pertaining to medicine and alchemy, or to matters celestial 
or terrestrial. He has worked diligently in the smelting of ores 
as also in the working of minerals; he is thoroughly acquainted with 
all sorts of arms and implements used in military service and in 
hunting, besides which he is skilled in agriculture and in the meas 
urement of lands. It is impossible to write a useful or correct 
treatise in experimental philosophy without mentioning this man s 
name. Moreover, he pursues knowledge for its own sake; for if he 
wished to obtain royal favor, he could easily find sovereigns who 
would honor and enrich him. 

Similar expressions might readily be quoted from 
Thomas Aquinas, but his works are so easy to secure 

1 " De Coelo et Mundo," 1, tr. iv., s. 


and his whole attitude of mind so well known, that 
it scarcely seems worth while taking space to do so. 
Aquinas is still studied very faithfully in many uni 
versities, and within the last few years one of his 
great text-books of philosophy has been replaced in 
the curriculum of Oxford University, in which it 
occupied a prominent position in the long ago, as 
a work that may be offered for examination in the 
department of philosophy. It is with regard to him 
particularly that there has been the greatest revul 
sion of feeling in recent years and a recognition of 
the fact that here was a great thinker familiar with 
all that was known in the physical sciences, and who 
had this knowledge constantly in his mind when he 
drew his conclusions with regard to philosophical and 
theological questions. 

It used to be the fashion to make little of the 
medieval scholars for the high estimation in which 
they held Aristotle. Occasionally even yet one hears 
narrowly educated men, I am sorry to say much 
more frequently scientific specialists than others, 
talk deprecatingly of this ardent devotion to Aris 
totle. No one who knows anything about Aristotle 
ever indulges in such an exhibition of ignorance of 
the realities of the history of philosophy and science. 
To know Aristotle well is to think of him as proba 
bly possessed of the greatest human mind that ever 
existed. We do not need to go back to the Middle 
Ages to be confirmed in that opinion. Modern sci 
entists who know their science well, but who also 
know Aristotle well, and who are ardent worship 
pers at his shrine, are not hard to find. Romanes, 
the great English biologist of the end of the nine 
teenth century, said: " It appears to me that there 
can be no question that Aristotle stands forth not 
only as the greatest figure in antiquity but as the 
greatest intellect that has ever appeared upon this 


Before Romanes, George H. Lewes, in his inter 
esting monograph in the history of thought, Aris 
totle, a Chapter in the History of Science," is quite 
as complimentary to the great Greek thinker. We 
may say that Lewes was by no means partial to 
Aristotle. Anything but inclined to accept author 
ity as of value in philosophy, he had been rendered 
impatient by the fact that so much of the history 
of philosophy was dominated by Aristotle, and it 
was only that the panegyric was forced from him 
by careful study of all that the Stagirite wrote that 
he said : History gazed on him with wonder. His 
intellect was piercing and comprehensive; his attain 
ments surpassed those of every philosopher; his in 
fluence has been excelled only by the founders of 
religion . . . his vast and active intelligence for 
twenty centuries held the world in awe." 

Professor Osborn, whose scholarly study of the 
theory of evolution down the ages " From the Greeks 
to Darwin " rather startled the world of science 
by showing not only how old was a theory of evolu 
tion, but how frequently it had been stated and how 
many of them anticipated phases of our own thought 
in the matter, pays a high compliment to the great 
Greek scientist. He says: " Aristotle clearly states 
and rejects a theory of the origin of adaptive struc 
tures in animals altogether similar to that of Dar 
win." He then quotes certain passages from Aris 
totle s "Physics," and says: "These passages 
seem to contain absolute evidence that Aristotle had 
substantially the modern conception of the evolution 
of life, from a primordial, soft mass of living matter 
to the most perfect forms, and that even in these he 
believed that evolution was incomplete for they 
were progressing to higher forms." 

Modern French scientists are particularly lauda 
tory in their estimation of Aristotle. The group 
of biologists, Buffon, Cuvier, St. Hilaire, and others 


who called world attention to French science and its 
attainments about a century ago, are all of them on 
record in highest praise of Aristotle. Cuvier said: 
I cannot read his work without being ravished with 
astonishment. It is impossible to conceive how a 
single man was able to collect and compare the multi 
tude of facts implied in the rules and aphorisms con 
tained in this book." 

It is possible, however, to get opinions ardently 
laudatory of Aristotle from the serious students of 
any nation, provided only they know their Aristotle. 
Sir William Hamilton, the Scotch philosopher, said : 

" Aristotle s seal is upon all the sciences, his spec 
ulations have determined those of all subsequent 
thinkers," Hegel, the German philosophic writer, 
is not less outspoken in his praise : " Aristotle pene 
trated the whole universe of things and subjected 
them to intelligence." Kant, who is often said to 
have influenced our modern thinking more than any 
other in recent generations, has his compliment for 
Aristotle. It relates particularly to that branch of 
philosophy with which Kant had most occupied him 
self. The Koenigsberg philosopher said : Logic 
since Aristotle, like Geometry since Euclid, is a fin 
ished science." 

I do not want to tire you or I could quote many 
other authorities who proclaim Aristotle the genius 
of the race. They would include poets like Dante 
and Goethe, scholars like Cicero and Anthon, literary 
men like Lessing and Reich and many others. The 
scholars of the Middle Ages, far from condemnation 
for their devotion to Aristotle, deserve the highest 
praise for it. If they had done nothing else but ap 
preciate Aristotle as our greatest modern scholars 
have done, that of itself would proclaim their pro 
found scholarship. 

The medieval writers are often said to have been 
uncritical in their judgment, but in their lofty esti- 


mation of Aristotle they displayed the finest possible 
critical judgment. On the contrary, the generations 
who made much of the opportunity to minimize me 
dieval scholarship because of its worship at the 
shrine of Aristotle, must themselves fall under the 
suspicion at least of either not knowing Aristotle 
or of not thinking deeply about the subjects with 
regard to which he wrote. For in all the world s his 
tory the rule has been that whenever men have 
thought deeply about a subject and know what Aris 
totle has written with regard to that subject, they 
have the liveliest admiration for the great Greek 
thinker. This is true for philosophy, logic, meta 
physics, politics, ethics, dramatics, but it is also 
quite as true for physical science. He lacked our 
knowledge, though not nearly to the degree that is 
usually thought, and he had a marvellous accumula 
tion of information, but he had a breadth of view 
and a thoroughness of appreciation with a power 
of penetration that make his opinions worth while 
knowing even on scientific subjects in our enlight 
ened age. 

As for the supposed swearing by Aristotle, in the 
sense of literally accepting his opinions without dar 
ing to examine them critically, which is so constantly 
asserted to have been the habit of the medieval schol 
ars and teachers, it is extremely difficult in the light 
of the expressions which we have from them, to 
understand how this false impression arose. Aris 
totle they thoroughly respected. They constantly 
referred to his works, but so has every thinking gen 
eration ever since. Whenever he " had made a 
declaration they would not accept the contradiction 
of it without a good reason, but whenever they had 
good reasons, Aristotle s opinion was at once re 
jected without compunction. Albertus Magnus, for 
instance, said : Whoever believes that Aristotle 
was a &od must also believe that he never erred, 


but if we believe that Aristotle was a man, then 
doubtless he was liable to err just as we are." A 
number of direct contradictions of Aristotle we have 
from Albert. A well-known one is that with regard 
to Aristotle s assertion that lunar rainbows ap 
peared only twice in fifty years. Albert declared 
that he himself had seen two in a single year. 

Indeed, it seems very clear that the whole trend 
of thought among the great teachers of the time was 
away from the acceptance of scientific conclusions 
on authority unless there was good evidence for 
them available. They were quite as impatient as the 
scientists of our time with the constant putting for 
ward of Aristotle as if that settled a scientific ques 
tion. Eoger Bacon wanted the Pope to forbid the 
study of Aristotle because his works were leading 
men astray from the study of science, his authority 
being looked upon as so great that men did not think 
for themselves but accepted his assertions. Smaller 
men are always prone to do this, and indeed it con 
stitutes one of the difficulties in the way of advance 
in scientific knowledge at all times, as Roger Bacon 
himself pointed out. 

These are the sort of expressions that are to be 
expected from Friar Bacon from what we know of 
other parts of his work. His Opus Tertium was 
written at the request of Pope Clement IV, because 
the Pope had heard many interesting accounts of 
what the great thirteenth-century teacher and experi 
menter was doing at the University of Oxford, and 
wished to learn for himself the details of his work. 
Bacon starts out with the principle that there are 
four grounds of human ignorance. These are, " first, 
trust in inadequate authority; second, that force of 
custom which leads men to accept without properly 
questioning what has been accepted before their 
time; third, the placing of confidence in the asser 
tions of the inexperienced ; and fourth, the hiding of 


one s own ignorance behind the parade of superficial 
knowledge, so that we are afraid to say I do not 
know." Professor Henry Morley, a careful student 
of Bacon s writings, said with regard to these ex 
pressions of Bacon: 

No part of that ground has yet been cut away from beneath the feet 
of students, although six centuries have passed. We still make sheep- 
walks of second, third and fourth, and fiftieth hand references to 
authority; still we are the slaves of habit, still we are found fol 
lowing too frequently the untaught crowd, still we flinch from the 
righteous and wholesome phrase " I do not know " and acquiesce 
actively in the opinion of others that we know what we appear to 

In his " Opus Ma jus " Bacon had previously given 
abundant evidence of his respect for the experi 
mental method. There is a section of this work 
which bears the title " Scientia Experimentalis." 
In this Bacon affirms that " without experiment 
nothing can be adequately known. An argument may 
prove the correctness of a theory, but does not give 
the certitude necessary to remove all doubt, nor will 
the mind repose in the clear view of truth unless it 
finds its way by means of experiment." To this he 
later added in his " Opus Tertium ": " The strong 
est argument proves nothing so long as the conclu 
sions are not verified by experience. Experimental 
science is the queen of sciences, and the goal of all 

It is no wonder that Dr. Whewell, in his History 
of the Inductive Sciences," should have been un 
stinted in his praise of Roger Bacon s work and 
writings. In a well-known passage he says of the 
Opus Ma jus : 

Roger Bacon s " Opus Majus " is the encyclopedia and " Nbvum 
Organon " of the thirteenth century, a work equally wonderful with 
regard to its wonderful scheme and to the special treatises by 
which the outlines of the plans are filled up. The professed object 
of the work is to urge the necessity of a reform in the mode of 
philosophizing, to set forth the reasons why knowledge had not made 
greater progress, to draw back attention* to the sources of knowl- 


edge which had been unwisely neglected, to discover other sources 
which were yet almost untouched, and to animate men in the, 
undertaking of a prospect of the vast advantages which it offered. 
In the development of this plan all the leading portions of science 
are expanded in the most complete shape which they had at that 
time assumed; and improvements of a very wide and striking kind 
are proposed in some of the principal branches of study. Even if the 
work had no leading purposes it would have been highly valuable as 
a treasure of the most solid knowledge and soundest speculations 
of the time; even if it had contained no such details it would have 
been a work most remarkable for its general views and scope. 

As a matter of fact the universities of the Middle 
Ages, far from neglecting science, were really scien 
tific universities. Because the universities of the 
early nineteenth century occupied themselves almost 
exclusively with languages and especially formed 
students minds by means of classical studies, men in 
our time seem to be prone to think that such lin 
guistic studies formed the main portion of the cur 
riculum of the universities in all the old times and 
particularly in the Middle Ages. The study of the 
classic languages, however, came into university life 
only after the Renaissance. Before that the under 
graduates of the universities had occupied them 
selves almost entirely with science. It was quite as 
much trouble to introduce linguistic studies into the 
old universities in the Renaissance time to replace 
science, as it was to secure room for science by push 
ing out the classics in the modern time. Indeed the 
two revolutions in education are strikingly similar 
when studied in detail. Men who had been brought 
up on science before the Renaissance were quite sure 
that that formed the best possible means of develop 
ing the mind. In the early nineteenth century men 
who had been formed on the classics were quite as 
sure that science could not replace them with any 

There is no pretence that this view of the medieval 
universities is a new idea in the history of educa 
tion. Those who have known the old universities at 


first hand by the study of the actual books of their 
professors and by familiarity with their courses of 
study, have not been inclined to make the mistake 
of thinking that the medieval university neglected 
science. Professor Huxley in his " Inaugural Ad 
dress as Rector of Aberdeen University some 
thirty years ago stated very definitely his recognition 
of medieval devotion to science. His words are well 
worth remembering by all those who are accustomed 
to think of our time as the first in which the study 
of science was taken up seriously in our universities. 
Professor Huxley said : 

The scholars of the medieval universities seem to have studied 
grammar, logic, and rhetoric; arithmetic and geometry; astronomy, 
theology, and music. Thus their work, however imperfect and faulty, 
judged by modern lights, it may have been, brought them face to 
face with all the leading aspects of the many-sided mind of man. 
For these studies did really contain, at any rate in embryo, some 
times it may be in caricature, what we now call philosophy, mathe 
matical and physical science, and art. And I doubt if the curriculum 
of any modern university shows so clear and generous a comprehen 
sion of what is meant by culture, as this old Tritium and Quadrivium 

It would be entirely a mistake, however, to think 
that these great writers and teachers who influenced 
the medieval universities so deeply and whose works 
were the text-books of the universities for centuries 
after, only had the principles of physical and ex 
perimental science and did not practically apply 
them. As a matter of fact their works are full of 
observation. Once more, the presumption that they 
wrote only nonsense with regard to science comes 
from those who do not know their writings at all, 
while great scientists who have taken the pains to 
study their works are enthusiastic in praise. Hum- 
boldt, for instance, says of Albertus Magnus, after 
reading some of his works with care : 

Albertus Magnus is equally active and influential in promoting the 
study of natural science and of the Aristotelian philosophy. Hia 
works contain some exceedingly acute remarks on the organic struc- 


ture and physiology of plants. One of his works bearing the title of 
" Liber Cosmographicus De Nature Locorum " is a species of physical 
geography. I have found in it considerations on the dependence of 
temperature concurrently on latitude and elevation and on the tffect 
of different angles of the sun s rays in heating the ground which have 
excited my surprise. 

It is with regard to physical geography of 
course that Hmnboldt is himself a distinguished 

Humboldt s expression that he found some exceed 
ingly acute remarks on the organic structure and 
physiology of plants in Albert the Great s writings 
will prove a great surprise to many people. Meyer, 
the German historian of botany, however, has 
re-echoed Humboldt s praise with emphasis. The 
extraordinary erudition and originality of Albert s 
treatise on plants drew from Meyer the comment : 

No botanist who lived before Albert can be compared with him 
unless Theophrastus, with whom he was not acquainted; and after 
him none has painted nature in such living colors or studied it so 
profoundly until the time of Conrad Gessner and Caesalpino. 

These men, it may be remarked, come three cen 
turies after Albert s time. A ready idea of Albert s 
contributions to physical science can be obtained 
from his life by Sighart, which has been translated 
into English by Dixon and was published in London 
in 1870. Pagel, in Puschmann s " History of Medi 
cine," already referred to, gives a list of the books 
written by Albert on scientific matters with some 
comments which are eminently suggestive, and fur 
nish solid basis for the remark that I have made, 
that men s minds were occupied with nearly the same 
problems in science in the thirteenth century as we 
are now, while the conclusions they came to were 
not very different from ours, though reached so long 
before us. 

This catalogue of Albertus Magnus works shows 
very well his own interest and that of his generation 
in physical science of all kinds. There were eight 


treatises on Aristotle s physics and on the under 
lying principles of natural philosophy and of energy 
and of movement; four treatises concerning the 
heavens and the earth, one on physical geography 
which also contains, according to Pagel, numerous 
suggestions on ethnography and physiology. There 
are two treatises on generation and corruption, six 
books on meteors, five books on minerals, three books 
on the soul, two books on the intellect, a treatise on 
nutritives, and then a treatise on the senses and an 
other on the memory and on the imagination. All 
the phases of the biological sciences were especially 
favorite subjects of his study. There is a treatise on 
the motion of animals, a treatise in six books on 
vegetables and plants, a treatise on breathing things, 
a treatise on sleep and waking, a treatise on youth 
and old age, and a treatise on life and death. His 
treatise on minerals contains, according to Pagel, a 
description of ninety-five different kinds of precious 
stones. Albert s volumes on plants were reproduced 
with Meyer, the German botanist, as editor (Berlin, 
1867). All of Albert s books are available in modern 
Pagel says of Albertus that 

His profound scholarship, his boundless industry, the almost incon- 
trollable impulse of his mind after universality of knowledge, the 
many-sidedness of his literary productivity, and finally the almost 
universal recognition which he received from his contemporaries and 
succeeding generations, stamp him as one of the most imposing char 
acters and one of the most wonderful phenomena of the Middle Ages. 

In another passage Pagel has said: 

While Albert was a Churchman and an ardent devotee of Aristotle, 
in matters of natural phenomena he was relatively unprejudiced and 
presented an open mind. He thought that he must" follow Hippocrates 
and Galen, rather than Aristotle and Augustine, in medicine and in 
the natural sciences. We must concede it a special subject of praise 
for Albert that he distinguished very strictly between natural and 
supernatural phenomena. The former he considered as entirely the 
object of the investigation of nature. The latter he handed over 
to the realm of metaphysics. 


Roger Bacon is, however, the one of these three 
great teachers who shows us how thoroughly prac 
tical was the scientific knowledge of the universities 
and how much it led to important useful discoveries 
in applied science and to anticipations of what is 
most novel even in our present-day sciences. Some 
of these indeed are so startling, that only that we 
know them not by tradition but from his works, 
where they may be readily found without any doubt 
of their authenticity, we should be sure to think that 
they must be the result of later commentators ideas. 
Bacon was very much interested in astronomy, and 
not only suggested the correction of the calendar, but 
also a method by which it could be kept from wander 
ing away from the actual date thereafter. He dis 
covered many of the properties of lenses and is said 
to have invented spectacles and announced very em 
phatically that light did not travel instantaneously 
but moved with a definite velocity. He is sometimes 
said to have invented gunpowder, but of course he 
did not, though he studied this substance in various 
forms very carefully and drew a number of conclu 
sions in his observations. He was sure that some 
time or other man would learn to control the energies 
exhibited by explosives and that then he would be 
able to accomplish many things that seemed quite 
impossible under present conditions. 

He said, for instance : 

Art can construct instruments of navigation, such that the largest 
vessels governed by a single man will traverse rivers and seas more 
rapidly than if they were filled with oarsmen. One may also maka 
carriages which without the aid of any animal will run with re 
markable swiftness. 

In these days when the automobile is with us and 
when the principal source of energy for motor pur 
poses is derived from explosives of various kinds, 
this expression of Eoger Bacon represents a 


prophecy marvellously surprising in its fulfilmeijt. 
It is no wonder that the book whence it comes bears 
the title " De Secretis Artis et Naturae." Roger 
Bacon even went to the extent, however, of declaring 
that man would some time be able to fly. He was 
even sure that with sufficient pains he could himself 
construct a flying machine. He did not expect to 
use explosives for his motor power, however, but 
thought that a windlass properly arranged, worked 
by hand, might enable a man to make sufficient move 
ment to carry himself aloft or at least to support 
himself in the air, if there were enough surface to 
enable him to use his lifting power to advantage. 
He was in intimate relations by letter with many 
other distinguished inventors and investigators be 
sides Peregrinus and was a source of incentive and 
encouragement to them all. 

The more one knows of Aquinas the more surprise 
there is at his anticipation of many modern scientific 
ideas. At the conclusion of a course on cosmology 
delivered at the University of Paris he said that 
" nothing at all would ever be reduced to nothing 
ness " (nihil omnino in nihilum redigetur}. He was 
teaching the doctrine that man could not destroy 
matter and God would not annihilate it. In other 
words, he was teaching the indestructibility of mat 
ter even more emphatically than we do. He saw 
the many changes that take place in material sub 
stances around us, but he taught that these were only 
changes of form and not substantial changes and 
that the same amount of matter always remained in 
the world. At the same time he was teaching that 
the forms in matter by which he meant the combina 
tions of energies which distinguish the various kinds 
of matter are not destroyed. In other words, he 
was anticipating not vaguely, but very clearly and 
definitely, the conservation of energy. His teaching 
jrith regard to the composition of matter was very 


like that now held by physicists. He declared that 
matter was composed of two principles, prime mat 
ter and form. By forma he meant the dynamic ele 
ment in matter, while by materia prima he meant the 
underlying substratum of material, the same in every 
substance, but differentiated by the dynamics of 

It used to be the custom to make fun of these me 
dieval scientists for believing in the transmutation 
of metals. It may be said that all three of these 
greatest teachers did not hold the doctrine of the 
transmutation of metals in the exaggerated way in 
which it appealed to many of their contemporaries. 
The theory of matter and form, however, gave a 
philosophical basis for the idea that one kind of 
matter might be changed into another. We no longer 
think that notion absurd. Sir William Ramsay has 
actually succeeded in changing one element into an 
other and radium and helium are seen changing into 
each other, until now we are quite ready to think of 
transmutation placidly. The Philosopher s Stone 
used to seem a great absurdity until our recent ex 
perience with radium, which is to some extent at 
least the philosopher s stone, since it brings about 
the change of certain supposed elements into others. 
A distinguished American chemist said not long ago 
that he would like to extract all the silver from a 
large body of lead ore in which it occurs so com 
monly, and then come back after twenty years and 
look for further traces of silver, for he felt sure that 
they would be found and that lead ore is probably 
always producing silver in small quantities and 
copper ore is producing gold. 

Most people will be inclined to ask where the fruits 
of this undergraduate teaching of science are to be 
found. They are inclined to presume that science 
was a closed book to the men and women of that time. 
It is not hard, however, to point the effect of the 


scientific training in the writings of the times. Dante 
is a typical university man of the period. He was 
at several Italian universities, was at Paris and per 
haps at Oxford. His writings are full of science. 
Professor Kiihns, of Wesleyan, in his book " The 
Treatment of Nature in Dante," has pointed out 
how much Dante knows of science and of nature. 
Few of the poets not only of his own but of any 
time have known more. There are only one or 
two writers of poetry in our time who go 
with so much confidence to nature and the 
scientific interpretation of her for figures for their 
poetry. The astronomy, the botany, the zoology 
of Albertus Magnus and Thomas Aquinas, Dante 
knew very well and used confidently for fig 
urative purposes. Anyone who is inclined to think 
nature study a new idea in the world forgets, or 
has never known, his Dante. The birds and the bees, 
the flowers, the leaves, the varied aspects of clouds 
and sea, the phenomena of phosphorescence, the 
intimate habits of bird and beast and the ways of 
the plants, as well as all the appearances of the 
heavens, Dante knew very well and in a detail that 
is quite surprising when we recall how little nature 
study is supposed to have attracted the men of his 
time. Only that his readers appreciated it all, Dante 
would surely not have used his scientific erudition 
so constantly. 

So much for the undergraduate department of the 
universities of the Middle Ages, and the view is abso 
lutely fair, for these were the men to whom the 
students flocked by thousands. They were teaching 
science, not literature. They were discussing physics 
as well as metaphysics, psychology in its phenomena 
as well as philosophy, observation and experiment 
as well as logic, the ethical sciences, economics, prac 
tically all the scientific ideas that were needed in 
their generation and that generation saw the rise 


of the universities, the finishing of the cathedrals, 
the building of magnificent town halls and castles 
and beautiful municipal buildings of many kinds, in 
cluding hospitals, the development of the Hansa 
League in commerce, and of wonderful manufac 
turers of all the textiles, the arts and crafts, as 
well as the most beautiful book-making and art and 
literature. We could be quite sure that the men who 
solved all the other problems so well could not have 
been absurd only in their treatment of science. Any 
one who reads their books will be quite sure of that. 

While most people might be ready, then, to con 
fess that possibly Huxley was not mistaken with 
regard to the undergraduate department of the uni 
versities, most of them would feel sure that at least 
the graduate departments were sadly deficient in 
accomplishment. Once more this is entirely an as 
sumption. The facts are all against any such idea. 

There were three graduate departments in most 
of the universities theology, law, and medicine. 
While physical scientists are usually not cognizant 
of it apparently, theology is a science, a department 
of knowledge developed scientifically, and most of 
these medieval universities did more for its scien 
tific development than the schools of any other 
period. Quite as much may be said for philosophy, 
for there are many who hesitate to attribute any 
scientific quality to modern developments in the mat 
ter. As for law, this is the great period of the 
foundation of scientific law development; the Eng 
lish common law was formulated by Bracton, the 
deep foundations of basic French and Spanish law 
were laid, and canon law acquired a definite scientific 
character which it was always to retain. All this 
was accomplished almost entirely by the professors 
in the law departments of the universities. 

It was in medicine, however, where most people 
would be quite sure without any more ado that noth- 


ing worth while talking about was being done, that 
the great triumphs of graduate teaching at the me 
dieval universities were secured. Here more than 
anywhere else is there room for supreme surprise at 
the quite unheard-of anticipations of our modern 
medicine and, stranger still, as it may seem, of our 
modern surgery. 

The law regulating the practice of medicine in the 
Two Sicilies about the middle of the thirteenth cen 
tury shows us the high standard of medical educa 
tion. Students were required to have three years 
of preliminary study at the university, four years 
in the medical department, and then practise for a 
year with a physician before they were allowed to 
practise for themselves. If they wanted to practise 
surgery, an extra year in the study of anatomy was 
required. I published the text of this law, which 
was issued by the Emperor Frederick II about 1241, 
in the Journal of the American Medical Association 
three years ago. It also regulated the practice of 
pharmacy. Drugs were manufactured under the in 
spection of the government and there was a heavy 
penalty for substitution, or for the sale of old inert 
drugs, or improperly prepared pharmaceutical ma 
terials. If the government inspector violated his 
obligations as to the oversight of drug preparations 
the penalty was death. Nor was this law of the Em 
peror Frederick an exception. "We have the charters 
of a number of medical schools issued by the Popes 
during the next century, all of which require seven 
years or more of university study, four of them in 
the medical department, before the doctor s degree 
could be obtained. When new medical schools were 
founded they had to have professors from certain 
well-recognized schools on their staff at the begin 
ning in order to assure proper standards of teaching, 
and all examinations were conducted under oath- 
bound secrecy and with the heaviest obligations on 


professors to be assured of the knowledge of students 
before allowing them to pass. 

It might be easy to think, and many people are 
prone to do so, that in spite of the long years of 
study required there was really very little to study 
in medicine at that time. Those who think so should 
read Professor Clifford Allbutt s address on the 
" Historical Relations of Medicine and Surgery 
delivered at the World s Fair at St. Louis in 1904. 
He has dwelt more on surgery than on medicine, but 
he makes it very clear that he considers that the 
thinking professors of medicine of the later Middle 
Ages were doing quite as serious work in their way 
as any that has been done since. They were care 
fully studying cases and writing case histories, they 
were teaching at the bedside, they were making val 
uable observations, and they were using the means 
at their command to the best advantage. Of course 
there are many absurdities in their therapeutics, but 
then we must not forget there have always been 
many absurdities in therapeutics and that we are not 
free from them in our day. Professor Eichet, at 
the University of Paris, said not long ago: " The 
therapeutics of any generation is quite absurd to the 
second succeeding generation." We shall not blame 
the medieval generations for having accepted reme 
dies that afterwards proved inert, for every genera 
tion has done that, even our own. 

Their study of medicine was not without lasting 
accomplishment, however. They laid down the indi 
cations and the dosage for opium. They used iron 
with success, they tried put many of the bitter tonics 
among the herbal medicines, and they used laxatives 
and purgatives to good advantage. Down at Mont- 
pellier, Gilbert, the Englishman, suggested red light 
for smallpox because it shortened the fever, lessened 
the lesions, and made the disfigurement much less. 
Finsen was given the Nobel prize partly for re-dis- 


covery of this. They segregated erysipelas and so 
prevented its spread. They recognized the con 
tagiousness of leprosy, and though it was probably 
as widespread as tuberculosis is at the present time, 
they succeeded not only in controlling but in eventu 
ally obliterating it throughout Europe. 

It was in surgery, however, that the greatest tri 
umphs of teaching of the medieval universities were 
secured. Most people are inclined to think that 
surgery developed only in our day. The great 
surgeons of the thirteenth and fourteenth centuries, 
however, anticipated most of our teaching. They 
investigated the causes of the failure of healing by 
first intention, recognized the danger of wounds of 
the neck, differentiated the venereal diseases, de 
scribed rabies, and knew much of blood poisoning, 
and operated very skilfully. "We have their text 
books of surgery and they are a never-ending source 
of surprise. They operated on the brain, on the 
thorax, on the abdominal cavity, and did not hesi 
tate to do most of the operations that modern sur 
geons do. They operated for hernia by the radical 
cure, though Mondeville suggested that more people 
were operated on for hernia for the benefit of the 
doctor s pocket than for the benefit of the patient. 
Guy de Chauliac declared that in wounds of the in 
testines patients would die unless the intestinal 
lacerations were sewed up, and he described the 
method of suture and invented a needle holder. We 
have many wonderful instruments from these early 
days preserved in pictures at least, that show us 
how much modern advance is merely re-invention. 

They understood the principles of aseptic surgery 
very well. They declared that it was not necessary 
" that pus should be generated in wounds." Pro 
fessor Clifford Allbutt says : 

They washed the wound with wine, scrupulously removing every 
foreign particle; then they brought the edges together, not allowing 


wine or anything else to remain within dry adhesive surfaces were 
their desire. Nature, they said, produces the means of union in a 
viscous exudation, or natural balm, as it was afterwards called by 
Paracelsus, Pare, and Wurtz. In older wounds they did their best 
to obtain union by cleansing, desiccation, and refreshing of the 
edges. Upon the outer surface they laid only lint steeped in wine. 
Powders they regarded as too desiccating, for powder shuts in decom 
posing matters; wine after washing, purifying, and drying the raw 
surfaces evaporates. 

Almost needless to say these are exactly the prin 
ciples of aseptic surgery. The wine was the best 
antiseptic that they could use and we still use alcohol 
in certain cases. It would seem to many quite im 
possible that such operations as are described could 
have been done without anaesthetics, but they were 
not done without anaesthetics. There were two or 
three different forms of anaesthesia used during the 
thirteenth and fourteenth centuries. One method 
employed by Ugo da Lucca consisted of the use of 
an inhalant. We do not know what the material 
employed was. There are definite records, however, 
of its rather frequent employment. 

What a different picture of science at the medieval 
universities all this makes from what we have been 
accustomed to hear and read with regard to them. It 
is difficult to understand where the old false impres 
sions came from . The picture of university work 
that recent historical research has given us shows 
us professors and students busy with science in every 
department, making magnificent advances, many of 
which were afterwards forgotten, or at least allowed 
to lapse into desuetude. 

The positive assertions with regard to old-time 
ignorance were all made in the course of religious 
controversy. In English-speaking countries partic 
ularly it became a definite purpose to represent the 
old Church as very much opposed to education of all 
kinds and above all to scientific education. There 
is not a trace of that to be found anywhere, but there 
were many documents that were appealed to to con- 


firm the protestant view. There was a Papal bull, 
for instance, said to forbid dissection. When read 
it proves to forbid the cutting up of bodies to carry 
them to a distance for burial, an abuse wihicli caused 
the spread of disease, and was properly prohibited. 
The Church prohibition was international and there 
fore effective. At the tim e the bull was issued there 
were twenty medical schools doing dissection in 
Italy and they continued to practise it quite undis 
turbed during succeeding centuries. The Papal phy 
sicians were among the greatest dissectors. Dis 
sections were done at Rome and the cardinals at 
tended them. Bologna at the height of its fame was 
in the Papal States. All this has been ignored and 
the supposed bull against anatomy emphasized as 
representing the keynote of medical and surgical his 
tory. Then there was a Papal decree forbidding the 
making of gold and silver. This was said to forbid 
chemistry or alchemy and so prevent scientific prog 
ress. The history of the medical schools of the time 
shows that it did no such thing. The great al 
chemists of the time doing really scientific work were 
all clergymen, many of them very prominent ecclesi 

Just in the same way there were said to be decrees 
of the Church councils forbidding the practice of 
surgery. President White says in his " Warfare 
of Science with Theology in Christendom," that, 
as a consequence of these, surgery was in dishonor 
until the Emperor Wenceslaus, at the beginning of 
the fifteenth century, ordered that it should be re 
stored to estimation. As a matter of fact, during 
the two centuries immediately preceding the first 
years of the fifteenth century, surgery developed 
very wonderfully, and we have probably the most 
successful period in all the history of surgery ex 
cept possibly our own. The decrees forbade monks 
to practise surgery because it led to certain abuses. 


Those who found these decrees and wanted to be 
lieve that they prevented all surgical development 
simply quoted them and assumed there was no 
surgery. The history of surgery at this time is 
one of the most wonderful chapters in human 

The more we know of the Middle Ages the more 
do we realize how much they accomplished in every 
department of intellectual effort. Their develop 
ment of the arts and crafts has never been equalled 
in the modern time. They made very great litera 
ture, marvellous architecture, sculpture that rivals 
the Greeks , painting that is still the model for our 
artists, surpassing illuminations; everything that 
they touched became so beautiful as to be a model 
for all the after time. They accomplished as much 
in education as they did in all the other arts, their 
universities had more students than any that have 
existed down to our own time, and they were en 
thusiastic students and their professors were ardent 
teachers, writers, observers, investigators. While 
we have been accustomed to think of them as neglect 
ing science, their minds were occupied entirely with 
science. They succeeded in anticipating much more 
of our modern thought, and even scientific progress, 
than we have had any idea until comparatively re 
cent years. The work of the later Middle Ages in 
mathematics is particularly strong, and was the 
incentive for many succeeding generations. Roger 
Bacon insisted that, without mathematics, there 
was no possibility of real advance in physical sci 
ence. They had the right ideas in every way. 
While they were occupied more with the philo 
sophical and ethical sciences than we are, these were 
never pursued to the neglect of the physical sciences 
in the strictest sense of that term. 

Is it not time that we should drop the foolish no 
tions that are very commonly held because we know 


nothing about the Middle Ages and, therefore, the 
more easily assume great knowledge and get back 
to appreciate the really marvellous details of educa 
tional and scientific development which are so inter 
esting and of so much significance at this time? 


The idea of collecting general information from 
many sources, of bringing it together into an easily 
available form, so as to save others labor, of writing 
it out in compendious fashion, so that it could readily 
pass from hand to hand, is likely to be considered 
typically modern. As a matter of fact, the Middle 
Ages furnish us with many examples of the pop 
ularization of science, of the writing of compendia 
of various kinds, of the gathering of information to 
save others the trouble, and, above all, of the making 
of what, in the modern time, we would call encyclo 
pedias. Handbooks of various kinds were issued, 
manuals for students and specialists, and many men 
of broad scholarship in their time devoted them 
selves to the task of making the acquisition of knowl 
edge easy for others. This was true not only for 
history and philosophy and literature, but also for 
science. It is not hard to find in each century of 
the Middle Ages some distinguished writer who de 
voted himself to this purpose, and for the sake of 
the light that it throws on these scholars, and the 
desire for information that must have existed very 
commonly since they were tempted to do the work, 
it seems worth while to mention here their names, 
and those of the books they wrote, with something 
of their significance, though the space will not per 
mit us to give here much more than a brief catalogue 
raisonne of such works. 

Very probably the first who should be mentioned 
in the list is Boethius, who flourished in the early 



part of the sixth century. He owed much of his edu 
cation to his adoptive father, afterwards his father- 
in-law, Symmachus, who, with Festus, represented 
scholarship at the court of the Gothic King, Theo- 
doric of Verona. These three Festus, Symmachus, 
and Boethius brought such a reputation for knowl 
edge to the court that they are responsible for many 
of the wonderful legends of Dietrich of Bern, as 
Theodoric came to be called in the poems of the 
medieval German poets. The three distinguished 
and devoted scholars did much to save Greek culture 
at a time when its extinction was threatened, and 
Boethius particularly left a series of writings that 
are truly encyclopedic in character. There are five 
books on music, two on arithmetic, one on geometry, 
translations of Aristotle s treatises on logic, with 
commentaries; of Porphyry s " Isagoge," with com 
mentaries, and a commentary on Cicero s " Topica." 
Besides, he wrote several treatises in logic and 
rhetoric himself, one on the use of the syllogism, and 
one on topics, and in addition a series of theological 
works. His great " Consolations of Philosophy 
was probably the most read book in the early Middle 
Ages. It was translated into Anglo-Saxon by 
King Alfred, into old German by Notker Teuto- 
nicus, the German monk of St. Gall, and its influence 
may be traced in Beowulf, in Chaucer, in High Ger 
man poetry, in Anglo-Norman and Provencal pop 
ular poetry, and also in early Italian verse. Above 
all, the " Divine Comedy " has many references to 
it, while the " Convito " would seem to show that 
it was probably the book that most influenced Dante. 
Though it is impossible to confirm by documentary 
evidence the generally accepted idea that Boethius 
died a martyr for Christianity, the tradition can be 
traced so far back, and it has been so generally ac 
cepted that this seems surely to have been the case. 
The fact is interesting, as showing the attitude of 


scholars towards the Church and of the Church 
towards scholarship thus early. 

The next great name in the tradition should prob 
ably be that of Cassiodorus, the Roman writer and 
statesman, prime minister of Theodoric, who, after 
a busy political life, retired to his estate at Viva 
rium, and, in imitation of St. Benedict, who had re 
cently established a monastery at Monte Cassino, 
founded a monastery there. He is said to have lived 
to the age of ninety-three. His retirement favored 
this long life, for, after the death of Theodoric, 
troublous times came, and civil war, and only his 
monastic privileges saved him from the storm and 
stress of the times. He had been interested in lit 
erature and the collection of information of many 
kinds before his retirement, and it is not unlikely 
that his recognition of the fact that the monastic 
life offered opportunities for the pursuit of this, un 
der favorable circumstances, led him to take it up. 

While still a statesman he wrote a series of works 
relating to history and politics and public affairs 
generally. These consisted mainly of chronicles 
and panegyrics, and twelve books of miscellanies 
called Variae. After his retirement to the mon 
astery, a period of ardent devotion to writing be 
gins, and a great number of books were issued. He 
evidently gathered round him a number of men 
whom he inspired with his spirit, or, perhaps, 
selected, because he found that, while they had a 
taste for a quiet, peaceful spiritual life, they were 
also devoted to the accumulation and diffusion of 
knowledge. A series of commentaries on portions 
of the Scriptures was written, the Jewish antiquities 
of Josephus translated, and the ecclesiastical his 
tories of Theodoric, Sozomen, and Socrates made 
available in Latin. Cassiodorus himself is said to 
have made a compendium of these, called the " His- 
toria Tripartita," which was much used as a manual 


of history during succeeding centuries. Then there 
were treatises on grammar, on orthography, and a 
series of works on mathematics. In all of his writ 
ings Cassiodorus shows a special fondness for the 
symbolism of numbers. 

There is a well-grounded tradition that he in 
sisted on the study of the Greek classics of medical 
literature, especially Hippocrates and Galen, and 
awakened the interest of the monks in the necessity 
for making copies of these fathers of medicine. The 
tradition that he established at Vivarium is also 
found to have existed at Monte Cassino among the 
Benedictines, and, doubtless, to this is to be at 
tributed the foundation of the medical school of 
Salerno, where Benedictine influence was so strong. 
It is probable, therefore, that to Cassiodorus must 
be attributed the preservation in as perfect a state 
as we have them of the old Greek medical writers. 

His main idea was, of course, the study of Scrip 
tures, but with just as many helps as possible. He 
thought that commentators, and historians, not alone 
Christian, but also Hebrew and Pagan, should be 
studied to illustrate it, and then the commentaries of 
the Latin fathers, so that a thoroughly rounded 
knowledge of it should be obtained. He thus began 
an " Encyclopedia Biblica," and set a host of work 
ers at its accomplishment. 

Every country in Europe shared this movement 
for the diffusion of information during the early 
Middle Ages, and the works of men from each of 
these countries in succeeding centuries has come 
down to us, preserved in spite of all the vicissitudes 
to which they were so liable during the centuries 
before the invention of printing and the easy multi 
plication of books. To many people it will seem 
surprising to learn that the next evidence of deep 
broad interest in knowledge is to be found in the 
next century in the distant west of Europe, in the 


Spanish Peninsula. It is a long step from the semi- 
barbaric splendor of the Gothic court at Verona, to 
the bishop s palace in Seville in Andalusia. The 
two cities are separated by what is no inconsider 
able distance in our day. In the seventh century 
they must have seemed almost at the other end of 
the world from each other. Those who recall what 
we have insisted on in several portions of the body 
of this work with regard to the high place Spanish 
genius won for itself in the Koman Empire, and how 
much of culture among the Spaniards of that time 
the occurrence of so many important writers of 
that nationality must imply, will not be surprised at 
the distinguished work of a great Christian Spanish 
writer of the seventh century. 

Indeed, it would be only what might be expected 
for evidences of early awakening of the broadest cul 
ture to be found in Spain. The important name in 
the popularization of science in the seventh cen 
tury is St. Isidore of Seville. He made a compen 
dium of all the scattered scientific traditions and 
information of his time with regard to natural 
phenomena in a sort of encyclopedia of science. 
This consisted of twenty books chapters we would 
call them now treating almost de omni re scibili et 
quibusdam aliis (everything knowable and a few 
other things besides). It is possible that the work 
may have been written by a number of collaborators 
under the patronage of the bishop, though there is 
no sure indication of this to be found either in the 
volume itself or even contemporary history. All 
the ordinary scientific subjects are treated. Astron 
omy, geography, mineralogy, botany, and even man 
and the animals have each a special chapter. 
Pouchet, in his " History of the Natural Sciences 
During the Middle Ages," calls attention to the fact 
that, in grouping the animals for collective treat 
ment in the different chapters, sometimes the most 


heterogeneous creatures are brought under a com 
mon heading. Among the fishes, for instance, are 
classed all living things that are found in water. 
The whale and the dolphin, as well as sponges, and 
oysters, and crocodiles, and sea serpents, and lob 
sters, and hippopotamuses, all find a place together, 
because of the common watery habitation. The 
early Spanish Churchman would seem to have had 
an enthusiastic zeal for complete classification that 
would surely have made him a strenuous modern 

The next link in the tradition of encyclopedic work 
is the Venerable Bede, whose character was more 
full} 7 honored by the decree on November 13, 1899, 
by Pope Leo XIII declaring him a Doctor of the 
Church. Bede was the fruit of that ardent scholar 
ship which had risen in England as a consequence 
of the introduction of Christianity. It had been 
fostered by the coming of scholar saints from Ire 
land, but was, unfortunately, disturbed by the in 
cursions of the Danes. While Bede is known for 
his greatest work, the " Ecclesiastical History of 
the English People," which gives an account of 
Christianity in England from its beginning until his 
own day, he wrote many other works. His history 
is the foundation of all our knowledge of early 
British history, secular as well as religious, and has 
been praised by historical writers of all ages, who 
turned to it for help with confidence. He wrote a 
number of other historical works. Besides, he 
wrote books on grammar, orthography, the metrical 
art, on rhetoric, on the nature of things, the sea 
sons, and on the calculation of the seasons. These 
latter books are distinctly scientific. His contribu 
tions to Gregorian Music are now of great value. 

After this, Alcuin and the monks, summoned by 
Charlemagne, take up the tradition of gathering and 
diffusing information, and the great monasteries of 


Tours, Fulda, and St. Gall carry it on. Besides 
these, in the ninth century Monte Cassino conies 
into prominence as an institution where much was 
done of what we would now call encyclopedic work. 
After his retirement from Salerno Constantine 
Africanus made his translations and commentaries 
on Arabian medicine, constituting what was really 
a medical encyclopedia of information not readily 
available at that time. 

After this, of course, the tradition is taken up 
by the universities, and it is only when, with the 
thirteenth century, there came the complete develop 
ment of the university spirit, that encyclopedias 
reached their modern expression. Three great en- 
cylopedists, Vincent of Beauvais, Thomas of Can- 
timprato, and Bartholomaeus Anglicus, are the most 
famous. Vincent consulted all the authors sacred 
and profane that he could lay hold on, and the num 
ber was, indeed, prodigious. I have given some ac 
count of him in " The Thirteenth Greatest of Cen 
turies " (Catholic Summer School Press, New York, 
third edition, 1910). 

It would be very easy to conclude that these en 
cyclopedias, written by clergymen for the general 
information of the educated people of the times, con 
tain very little that is scientifically valuable, and 
probably nothing of serious medical significance. 
Any such thought is, however, due entirely to un- 
familiarity with the contents of these works. They 
undoubtedly contain absurdities, they are often full 
of misinformation, they repeat stories on dubious 
authority, and sometimes on hearsay, but usually 
the source of their information is stated, and espe 
cially where it is dubious, as if they did not care to 
state marvels without due support. Books of pop 
ular information, however, have always had many 
queer things, queer, that is, to subsequent genera 
tions, and it is rather amusing to pick up an en- 


cyclopedia of a century ago, much less a millen 
nium ago, and see how many absurd things were ac 
cepted as true. The first edition of the " Encyclo 
pedia Britannica," issued one hundred and fifty 
years ago, furnishes an easily available source of 
the absurdities our more recent forefathers accepted. 
The men of the Middle Ages, however, were much 
better observers as a rule, and used much more crit 
ical judgment, according to their lights, than we 
have given them credit for. Often the information 
that they have to convey is not only valuable, but 
well digested, thoroughly practical, and sometimes a 
marvellous anticipation of some of our most modern 
thoughts. There is one of these encyclopedias which, 
because it was written in my favorite thirteenth 
century, I have read with some care. It is simply 
a development of the work of preceding clerical en 
cyclopedists, and often refers to them. Because it 
contains some typical examples of the better sorts 
of information in these works, I have thought it 
worth while to quote two passages from it. The 
author is Bartholomaeus Anglicus, and the quaint 
English in which it is couched is quoted from " Med 
ical Lore (London, 1893). The book is all the 
more interesting because in a dear old English ver 
sion, issued about 1540, the spellings of which are 
among the great curiosities of English orthography, 
it was often read and consulted by Shakespeare, who 
evidently quotes from it frequently, for not a little 
of the quaint scientific lore that he uses for his 
figures can be traced to expressions used in this 

The first of the paragraphs that deserves to be 
quoted, discusses madness, or, as we would call it, 
lunacy, and sums up the causes, the symptoms, and 
the treatment quite as well as that has ever been 
done in the same amount of space : 

Madness cometli sometime of passions of the soul, as of business 
and of great thoughts, of sorrow and of too great study, and of dread: 


sometime of the biting of a wood hound, or some other venomous 
beast; sometime of melancholy meats, and sometime of drink of strong 
wine. And as the causes be diverse, the tokens and signs be diverse. 
For some cry and leap and hurt and wound themselves and other men, 
und darken and hide themselves in privy and secret places. The medi 
cine of them is, that they be bound, that they hurt not themselves and 
other men. And namely, such shall be refreshed, and comforted, and 
withdrawn from cause and matter of dread and busy thoughts. And 
they must be gladded with instruments of music, and some deal be oc 

The second discusses in almost as thorough a way 
the result of the bite of a mad dog. The old Eng 
lish word for mad, wood, is constantly used. The 
causes, the symptoms, and course of the disease, and 
its possible prevention by early treatment, are all 
discussed. The old tradition was already in ex 
istence that sufferers from rabies or hydrophobia, 
as it is called, dreaded water, when it is really only 
because the spasm consequent upon the thought 
even of swallowing is painful that they turn from it. 
That tradition has continued to be very commonly 
accepted even by physicians down to our own day, 
so that Bartholomew, the Englishman, in the thir 
teenth century, will not be blamed much for setting 
it forth for popular information in his time some 
seven centuries ago. The idea that free bleeding 
would bring about the removal of the virus is inter 
esting, because we have in recent years insisted in 
the case of the very similar disease, tetanus, on al 
lowing or deliberately causing wounds in which the 
tetanus microbe may have gained an entrance, to 
bleed freely. 

The biting of a wood hound is deadly and venomous. And such 
venom is perilous. For it is long hidden and unknown, and in- 
creaseth and multiplieth itself, and is sometimes unknown to the 
year s end, and then the same day and hour of the biting, it cometh 
to the head, and breedeth frenzy. They that are bitten of a wood 
hound have in their sleep dreadful sights, and are fearful, astonied, 
and wroth without cause. And they dread to be seen of other men, 
and bark as hounds, and they dread water most of all things, and 
are afeared thereof full sore and squeamous also. Against the biting 
of a wood hound wise men and ready use to make the wounds bleed 
with fire or with iron, that the venom may come out with the 
blood, that cometh out of the wound. 


Abbassides, 73 

Abba Oumna, 70 

Abbas, 324 

Abelard, 189 

Abraham, 97, 98 

Abu Dschafer, 173 

Abulcasis, 123, 170, 226, 317, 

318, 323 
Abul Farag, 51 
Abulkasim, 124 
Academy of Bagdad, 135 
Acid, hydrochloric, 369 
Ackermann, 302 
Adalberon, 145 
Adelard of Bath, 134 
Adhesions, 128 
^Egidius, 150 
Aetius, 10, 117, 180, 317 
Aetius, Amidenus, 28 
Afflacius, 151, 171 
Affinity, 372 
Agenius, Otto, 227 
Agricola, 345 

A Kempis, Thomas, 345, 361 
Alanfrancus, 260 
Albertus Magnus, 267, 306, 356, 


Alchemist, 354 
Alcuin, 432 
Alderotti, 213 
Alexander II, Pope, 83 
Alexander of Hales, 108 
Alexander of Tralles, 10, 28, 39 
Alexandria, 135, 385 
Allbutt, Sir Clifford, 247, 254, 

257, 304, 355, 421 
All Abbas, 121, 173, 266, 323 
Ali Ben el Abbas, 170 
Almansor, 132 
Alphanus, 143, 145 
Amandaville, 264 
Anaesthesia, 17; inhalation of, 

295, 296 

Anaesthetics, 246 

Anathomia, 203 

Anatomy, ignorance of, 289; of 

the teeth, 326 
Anatomical material, 224 
Anatomical injection, 227 
Anatomical preparations, 277 
Andrew of Piacenza, 248 
Animals, motion of, 414 
Anthemios, 40 
Angelico, Fra, 360 
Angina, 32, 44, 332 
Anthon, 407 
Antimony, 362 
Antiseptic, 253 
Antisepsis. 17, 246 
Apocalypse, the chemical, 376 
Aquinas, 306, 403 
Arabian lack of originality, 140 
Arabian words in anatomy, 138 
Arabs, 7 
Arabisms, 237 
Archimattheas, 160 
Arcoli, John of, 208 
Arculanus, 323 
Arezzo, 248 

Arithmetical complementB, 340 
Armandaville, 264 
Arnold of Villanova, 290, 358 
Arrows, extraction of, 270 
Arpinum, 4 
Arsenic, 335 
Artemisia maritima, 50 
Arterial hemorrhage, 126 
Arthur Legends, 218, 375, 392 
Arts, 7; liberal, 149; and 

crafts, 425 

Asepsis, 17, 244, 246, 387 
Aspasia, 180 
Astrology, 105; and astronomy, 

106, 418 
Asylums, 8 
Auenbrugger, 91, 166 
Authority, 269, 292, 404 
Authorship, dual, 391 




Automobile. 415 

Avenzoar, 80, 123, 130, 132 

Averroes ( Averrhoes), 80, 123, 

132, 230, 267 
Avicenna, 80, 128, 170, 266, 

268, 331 
Avignon, 16, 233 


Baas, 61, 63 

Bachtischua, 56 

Bacon, Roger, 107, 306, 356, 3C1, 


Bagdad, 110, 111, 115, 134, 135 
Barbarians, 5 

Bartholomanis Anglicus, 433 
Bartholomew, 172 
Basilios. 26 
Basil. St.. 24 
Basila, 180 

Basil Valentine, 20, 180, 349 
Basra, 111 
Bath, 103 
Bath, milk, 131; in fever, 172; 

of the soul, 25 
Baverius, 209 

Barnes, Henry Samuel, 390 
Bede, 432 
Benedict. St., 178 
Benedictines, 12, 164 
Benedictine Xuns, 191 
Beowulf, 428 
Berengarius, 209 
Bernard of Clairvaux, 192 
Bernard, St., 85 
Bertruccio, 209, 287 
Bertruecius, 229 
Binz, Prof. Carl, 33S 
Birthplace, Latin writers, 4 
Black Death, 304 
Boccaccio, 183, 306 
Body-snatching, 224 
Boerhaave. 38 
Boethius, 427 
Bokhara, 111 

Bologna, 16, 142, 202, 206, 248 
Book-learning. 371 
Botany, 413; medieval, 414, 


Botticelli, 360 
Bracton, 419 
Brain substance, loss of, 294 

Brant, 361 

Brethren of the Common Lite 

Bridgework, dental, 315 

Broeck, 277 

Bronchoceles, .34 

Bruno da Longoburgo, 245, 248 

Bubonocele, 53 

Buffon, 406 

Bull, supposed against dissec 
tion, 424 

Busche, 344 

Bzowski, S. J., 181 

Caesalpinus, 2, 209 

Caius, 360 

Calenda, Constance, 187 

Calendar, correction of, 340 

Calvo, 302 

Cancer, 255 

Cantor, 346 

Carmoly, 61 

Carthage, 165 

Cases, desperate, 262 

Cassiodorus, 12, 429 

Cataract, 300 

Cato, 267 

Chanina Ben Chania, 66, 69 

Charlatans, numbers of, 274 

Charters, medical school, 420 

Charts, 19 

Chasdai Ben Schaprut, 79 

Chaucer, 306, 428 

Chauliac, 18, 285, 301, 319 

Chauliac, bibliography, 308; edi- 
tio princeps, 312 

Chemical compounds, artificial, 

Chirurgia Magna, 261, 284 

Chirurgy, 19 

Chosroes I, 109 

Church and Jews, 80; and anat 
omy, 234; and surgery, 234 

Cicatrices, beautiful, 255 

Cicero, 4, 427 

Cid, The, 218, 375, 392 

Cimabue. 211 

Circulation of the blood, 147 

Cities, large, 5 

City hospitals, 8; for the sick. 
24, 296 



City physician, 251 
Clavius, S. J., Father, 340 
Classics of Medicine, 165 
Clement of Alexandria, 83 ; VI, 

Pope, 83 
Cleopatra, 179 
Clepsydra, 341 
Clinical experience, 378 
Clitoris hypertrophy, 37 
Clysters, 279 
Cnidos, 135 
Colic, 279 

Collectio Salernitana, 143, 238 
College of St. Come, 26 
Colpeurynter, 128 
Columbus, 2, 209, 327, 329, 359 
Conception, 35 
Constantine Africanus, 5, 24, 

123, 134, 145, 151, 163, 236, 

266, 433 

Constitution of the sun, 339 
Consolations, 428 
Consumption, 44 
Conrad, 192 
Conrad Mutianus, 344 
Contrecoup, 240 
Convito, 428 
Copernicus, 346 
Copho, 154, 205 
Cordova, 75, 92, 134, 135 
Cornelius, 38 
Corrosive sublimate, 335 
Cos, 135 

Cosmas and Damien, 26 
Criticism, higher, 7 
Crown, dental, 316 ; cap, 316 
Cusanus, 336 
Cures of Afflacius, 171 
Cuvier, 406 
Cycloid curve, 346 

Dental appliances, 316; decay, 
318; hygiene, 325; surgery, 
327; instruments, 320 

Dent a tores, 320 

Dentrifices, 316 

Descartes, 133 

Desiderius, 145, 164, 168 

Deventer, 344 

Dezimeres, 302 

Diaphoresis, 47 

Diarbekir, 28 

Didacus Lopez, 130 

Diet, 46, 116 

Dietetics, 99, 157 

Di Liueci, 205 

Dinus de Garbo, 130 

Diogenes, 267 

Dioscoridea, 79, 266, 385 

Diphtheria, 32 

Diseases made incurable, 274 ; 
eye, 300 

D lsraeli, 76 

Dissecting material, 134; 
wounds, 227 

Dissection, 224; supposed pro 
hibition of, 424 

Divine Comedy, 428 

Divorce, 5 

Djondisabour, 71, 109 

Dock (Miss), 401 

Dog, rabid, 31 

Donolo, 78 

Drainage, 241, 249 

Dreams, 68 

Driesch, 399 

Dschibril, 57 

Dschordschis, 56 

Du Bouley, 199 

Duke, Robert, 167 

Duns Scotus, 108 


Da Lucca, 246 

Damascus, 111 

Daniel Morley, 134 

Dante, 183, 211, 306, 407, 417 

Daremberg, 180, 303 

Darwin, 355, 399 

David, 97 

Decadence, 6 


Eclecticism, 248 

Eclipse, 22 

Ecstasis, 386 

Eddyites, 385 

Edessa, 9 

Egidius, 134 

Elixir of immortal life, 25 

Embryology, 28 

De Renzi, 143, 162, 182, 238, 239 Encyclopedia biblica, 430 



Energy, Con8ervation of, 417 
Epilepsy, 43 
Epiplocele, 53 
Epiplo-enterocele, 53 
Epithelioma, 37 
Epulis, 32 

Erasistratus, 221, 385 
Erasmus, 344, 361 
Esophagus, 33 
Ethics, medical, 77 
Ethnography, 414 
Etruscans, 315 
Eusebius, 26 
Eustachius, 2, 209 
Eustachian canal, 327, 329 
Examinations, 136 
Experience, 403 
Experiment, master of, 404 

Fabiola, 11 

Fabricius de Acquapendente, 


Fallopius, 302, 327 
Farad j Ben Salim, 79, 170 
Faragut, 79 

Father of Modern Surgery, 283 
Faucon, 312 
Feminine education, 178, 188; 

cycles of, 200 
Ferrara, 248, 328 
Festus, 428 

Filling of the teeth, 335 
Finsen, 421 
First intention, 18 
Fish bones, 51 
Florence, 206, 248 
Floyer, 336 

Forefathers in medicine, 380 
Foreign body, 33 
Foreign bodies, 48 
Forli, 206 

Foster, Sir Michael, 354 
Foundlings, 8 
Foundling asylums, 25 
Founder of Pharmaceutical 

Chemistry, 353 
Four Masters, 154, 238, 242, 243, 

Fractures, 240; of pubic arch, 

128; of base, 242; of skull, 

244; split or crack, 243 

Francis, Dr. Samuel, 223 
Frederick I, 192; II, 147 
Freind, 112, 302 
Friedenwald, 64 
Friuli, 206 


Gaddesden, 287 

Galeatus de Sancta Sophia, 


Galileo, 355 
Galen, 3, 13, 35, 43, 73, 91, 

115, 117, 129, 179, 266, 230, 

204, 430, 385 
Galenists, 120 
Galvani, 166, 209 
Gario Pontus, 43 
Gentilis de Fulgiueis, 130 
Geography, physical, 413 
Geometric transmutation, 340 
Gerard of Cremona, 134, 170 
Ghetto, 62 
Giffert, Prof., 396 
Gilbert, 421 

Giliani, Alessandra, 188 
Gilles de Corbeil, 134, 150 
Giotto, 211, 306 
Giovanni of Arcoli, 313, 324, 


Glands, cervical, 259 
Goitre, 33, 151; cystic, 259 
Gold reserve, 316 
Gordon, Bernard, 276, 286 
Graduate, 208 
Grsecisms, 237 
Granada, 75 
Gratz College, 75 
Gravity, specific, 342 
Greeks, From the, to Darwin, 

Gregory IX, 83; of Nazianzen, 


Gruel, 131 
Guadalquivir, 93 
Guerini, 315 
Guimarug II, 143 
Guiscard, 145 
Gurlt, 29, 48, 109, 139, 156, 219, 

236, 239, 244, 248, 259, 312, 

329, 331 
Guy de Chauliac, 16, 208, 229, 

270, 275, 232, 422 



Haeser, 61 

Haliography, 376 

Hallam, 85 

Hamilton, Sir Wm., 407 

Harnack, 25, 26, 382, 392 

Haroun al-Raschid, 74 

Harvey, 166, 209, 355 

Harun al-Raschid, 56, 112 

Headache, 42 

Hegel, 407 

Hegira, 1 70 

Hegius, 345, 361 

Heidelberg, 345 

Helena, 24 

Heloise, 189 

Hemicrania, 42 

Hemoptyses, 45 

Heraclius, 54 

Hermondaville, 264 

Hernia, 208; radical cure of, 299 

Herophilus, 221, 384 

Hierakas. 26 

Hildegarde, 190 

Hippocrates, 13, 91, 99, 117, 266, 

385, 429 
" Histoire des Femmes Mdecins," 


Historia Tripartite, 429 
History of the Inductive Sci 
ences, 410 
Hobart, 393 
Hobelscb, 58 
Hollanduses, 358 
Homer, 375, 391 
Honein Ben Ischak, 57 
Honein Ben Ishac, 117 
Honey, 103 
Horae Lucanae, 390 
Horace, 267 

Hort-us Deliciarum, 191 
Hospitals, 8 

Hospitals for children, 25 
Hroswitha, 190 
Hugh of Lucca, 257 
Hugo of Lucca, 245, 267, 273 
Humboldt, 412 
Huxley, 150, 307. 412 
Hydrocephalua, 257 
Hydropikos, 385 
Hydrophobia, 435 
Hysteria, 54 

Ibn Sina, 128 

Ibn Zeinel-Taberi, 115 

Ibn-Zohr, 130 

Ignorance, on learaed, 340; 

grounds of, 4 CUt 
Irmorantia, De Docta, 339 
Iliac passion, 279 
Iliad, 375 
Illustrations, 230; dental, 331; 

first medical, 275 
Incunabula, 311, 329 
Infection, 241 
Innocent III. 63; IV, 83 
Insanity, 434 
Inspection, 47 

Invasion of the barbarians, 26 
Isaac Ben Amram, 70 
Isaac Ben Emram, 73 
Isaac Ben Soliman, 76 
Isaac Judams, 170, 173 
Isagoge. 58 
r~h:ic Ben Honein, 58 
Isidore of Seville, St., 113, 431 
Israels, A. H., 66 
Israeli, 76 

Jacobus de Forlivio, 130 

Jacobus de Partibus. 130 

Jewish physicians, 7 

Johannes Afflacius, 171 

Johannesbrod, 102 

Johannitius, 57 

John Chrysostom, St., 11, 181 

John de Vigo, 200 

John Masue, 74 

John of Arcoli, 18, 209 

John of Gaddesden, 286 

Josephus, 29 

Joshua Ben Nun, 74 

Jude Sabatai. 78 

Julian the Apostate, 8, 23 

Justinian, 26, 28 

Kant, 407 
Kerckringius, 366 
lurcher, 366 



Koran, 106, 139 
Kostaben Luka, 58 
Kulms, 418 

Lactantius, 27 

Lancisi, 209 

Landau, 67 

Lane Lectures, 354 

Lanfranc, 16, 209, 245, 260, 267 

Laurentian Library, 180 

Lead pipe, 239 

Leo, 55 

Leonardo da Vinci, 360 

Leonides, 36 

Leoparda, 181 

Lewes, 406 

Libraries, 6 

Life, intellectual, 5 

Ligatures, 155; around the 

limbs, 54 

Lilium Medicinae, 158 
Linacre, 209, 360 
Lipinska, Dr. Melanie, 195 
Livy, 4 
Lop ez, 82 
Love, 373 

Lowell, Russell, 371 
Lucan, 4, 94, 113 
Lucca, 248 
Lucretius, 395 
Ludwig s angina, 332 
Luke, St., 7; the physican, 8; 

supposed inaccuracies, 397 
Lupus, 256 


Machine, Flying, 416 

Madness, 434 

Magna Graecia, 15, 156, 177 

Magnet, 269 

Magnetism, 404 

Mahmoud, 75 

Maimonides, 12, 88, 90; rules 

of life, 100 
Malcorona, 182 
Malgaigne, 118, 303, 306 
Malpighi, 209 
Malta, 97 
Man, 95 

Mandeville, 264 

Mania, 44 

Manipulation, surgical, 250 

Mantua, 4 

Marsupium cordis, 15 

Martial, 4, 113, 181 

Maser Djawah, 72 

Matter and form, 351, 417 

Matter, indestructibility of, 416 

Matthaeus de Gradibus, 130 

Matthew Platearius, 134 

Mediastinum, 137 

lledica, 181 

Medical, first illustrations, 275 

Medicine, legal, 252; New York 

Academy of, 223 
Melancholia, 44 
Mengenberger, 276 
Meningitis, 43 
Mental influence, 44 
"Merchant of Venice, The," 82 
Mercuriade, 186 
Mesmer, 105 
Meteors, 414 
Metrodora, 180 
Metrorrhagia, 54 
Meyer, 413 
Michael AngeJo, 360 
Michael Scot, 134 
Microtechnics, 171 
Middle meningeal artery, 37 
Middleton, 246 
Migne, 194 
Milan, 206 

Milk, bath, 131; cure, 45 
Milman, 84 

Ministry of Christ, 390 
Miscellany, 124 
Modena, 248 
Mohammed, 13 
Monasteries, 6 
Mondeville, 207, 209, 231, 264, 

298, 422 
Mondino, 202, 209, 245; career, 

232; myth, 216 
Monks bane, 364 
Montaigne, 374 
Monte Cassino, 12, 145, 163, 168, 


Montpellier, 11, 16, 87, 265 
Morgagni, 91, 209 
Moses, 64 
Moses Ben Maimum, 91 




Nain, widow of, 389 

Naples, 248 

Nature, 47, 77, 378; in Dante, 


Neander, 84 
Needlebolder, 205 
Nemesius, 9 
Nerve suture, 253, 262 
Nestorian, 73, 109 
Newton, 351, 355 
Nibelungen, 218 
Nibelungenlied, 375, 392 
Nicaise, 198, 208, 265, 286, 292, 

302, 309 
Nicerata, 181 

Nicholas of Cusa, 19, 337, 344 
Nicolaus, Leonicenus, 130 
Nobel Prize, 421 
Noli me tangere, 25G 
Nosology, 159 
Notker Teutonicus, 428 
Novelties, medical, 166 
Nuremberg eggs, 337 
Nursing, 271; history of, 401 
Nutrition per rectum, 130 
Nutting, 401 

Observations, 282, 293, 378 
Octavius Horatianus, 180 
Odyssey, 375 
Oil and wine, 387 
Old Testament, 63 
Omar, 110 
Omentum, 250 
Operation for hernia, 52 
Ophthalmology, 258 
Opotherapy, 68 
Oppler, 100 
Opus Majus, 409 
Opus Tertium, 409 
Ordericus Vitalis, 182 
Organization of medical educa 
tion, 141 

Oribasius, 8, 38, 117 
Origenia, 180 
Orthodontia, 318 
Osborn, 40G 
Osier, 257 

Ossian, 375 
Ovid, 267 
Oxygen, 49 

Padua, 4, 16, 232, 248, 328, 345 
Pagel, 61, 111, 119, 152, 156, 

157, 172, 208, 216, 245, 264, 

277, 286, 230 
Palmyra, 109 
Palpation, 47 

Pandects, 38; of Haroun, 72 
Paracelsus, 2, 254, 379 
Paracentesis, 122, 365 
Paradiso, 215 
Pare, Ambroise, 254, 303 
Paris, 141 
Paris, Paulin, 310 
Passavant, Jean de, 260 
Passow, 386 
Pasquier, 200 
Paul of .-Egina, 10, 50, 117, 122, 

125, 317, 331 
Paulus ^Eginetus, 29, 38 
Pavia, 248 
Percussion, 19 
Peregrinus, 404 
Pergamos, 135, 385 
Perineum, torn, 184 
Persecutions, Christian, 4; of 

Jews, 83 
Persius, 4 
Perugia, 248 
Perugino, 360 
Peter of Spain, 300 
Petrarch, 306 
Petrus de Argentaria, 290 
Phagedenic ulcer, 35 
Pharmacy, 207 
Pharmacologist, 354 
Phenicia, 314 
Philip Augustus, 150 
Philosopher s stone, 369, 412 
Philosopher s keys, 376 
Phrenitis, 43 

Physicians and surgery, 267 
Physiology, history of, 354, 414 
Piacenza, 16, 232, 248 
Pilcher, Dr. Lewis, 215, 216, 

219, 229 

Pinturicchio, 360 
Pisa, 16, 248 



Pitard, Jean, 265, 269 

Plagiarism, medieval, 174 

Plague, 305 

Platearius I, 183 

Plato, 267, 292 

Pleurisy, 45 

Pliny, 4, 113 

Polyps, 31, 118, 258, 330; nasal, 
126, 258 

Pool, 93 

Pope Boniface VIII, 288 

Pope Clement VI, 300 

Pope Innocent VI, 300 

Pope John XXI, 300, 357 

Pope Urban V, 300 

Popes and Jews, 80; and sci 
ence, 148 

Popular Science Monthly, 400 

Porphyry. 428 

Portal", *304 

Portio vaginalis hypertrophy, 37 

Pouchet, 431 

Practice, medical, 15 

Preface, 230 

Priscian, 180 

Probe, 280 

Professional spirit, 141 

Professione Medicorum, 181 

Prohibition of chemistry, 424 

Prophylaxis, 47; perinea!, 185 

Prudt-ntius. 11:; 

Pseudo-philology, 364 

Psycho-analysis, 68 

Ptolemy, 73, 384 

" Puch der Xatur," 27"> 

Pulse. 19, 160 

Pure Drug Law, 420 

Puschmann, 41, 61, 144, 150 

Pus, unnecessary, 255 


Quackery, 273 
Quacks, "371 
Quadrivium, 149 
Quintilian, 4, 113 


Rab, 69 

Rabbi Ishmael. 06 
Rabies, 30; diagnosis of, 263, 
435; treatment, 262 

Radio-active elements, 350 

Radio-activity, 399 

Radium, 350 

Ragenifrid, 144 

Ramsay, Sir William, 394, 417 

Raphael, 360 

Rebecca Guarna, 186 

Reggio, 248 

Regimen Sanitatis, 158 

Regiomontanus, 360 

Religion of healing, 25 

Religious scruples, 224 

Renaissance, 20, 142 

Renan, 132, 314 

Rpspi ration rate, 342 

Reuchlin, 361 

Reynaud, M. Jean, 375 

Rhazes, 59, 114, 170, 266, 323, 

331; aphorisms, 116 
Richard C ceur de Lion, 98 
Richard the Englishman, 276 
Rima glottidis, 23 
Robinson, Dr. Nathaniel, 390 
Rodent ulcer, 35 
Rogero, 2:!7 
Roland, 273 
Rolando, 154, 238, 242 
Romanes, 405 

Roman Empire decadent, 5 
Roman patronage, 2 
Roman persecutions, 26 
Rome, 248 
Romoaldus, 134 
Rosa Anglice, 287 
Roth, 288 
Rudolph, 82 
Ruggero, 237 
Ruggiero, 146 
Rules of life, 100 
Rupertsberg, 192 
Rutebeuf, 183 

St. Benedict, 191 

St. Brigid, 179 

St. Dominic, 215 

St. Gall, 433 

St. Luke, 381, 382 

St. Patrick, 179 

St. Peter s Epistle, 398 

St. Thomas of Aquin, 352 



Saintsbury, 402 

Sacrament, 164 

Saladin, 90 

Salerno, 11, 13, 78, 141, 236, 


Salicet, 209, 247 
Salvation, 25 
Samarcand, 111 
Sanctions of belief, 105 
Sanitary science, 64 
Santa Sophia, 10, 40 
Saracenus, 171 
Saragossa, 75 
Scholarship, 130 
Scholastica, 178, 191 
Science, biological, 413; popular 

medieval, 425; medieval, 400 
Scientia Experimentalis, 410 
Scotus, 134 

Scribonius Largus, 180 
Kcrdbiculus cordis, 137 
Sea sponge, 151 
Semiotics, 159 
Seneca, 4, 94, 113, 267 
Serapion, 170 
Servetus, 2 
Seville, 75 
Shakespeare, 82 
Shawdepisse, 280 
Shower bath, 172 
Sidon, 314 
Sienna, 248 
Sighart, 413 
Signorelli, 360 
Silver Age, 13, 113 
Sintheim, 344 
Small-pox, 119 
Snake bites, 263 
Snare, 126 
Socrates, 292, 429 
Solomon, 98 
Sozomen, 429 
Spagyrist, 369 
Spallanzani, 209 
Spanish peninsula, 4 
Speculum, 331 
Sphudran, 386 
Sprengel, 77 
Standards of medical education, 


Static experiments, 340 
Steno, 366 
Studia generalia, 203 

Studies, post-graduate, 283 

Superstitions, 21 

Surgeon, as teacher, 261; qual 
ities of, 261, 305; good, 268; 
perfect, 268; training of, 267 

Surgery, aseptic, 245; antisgp- 
tic, 255; dishonor of, 424; 
epoch of, 281; Genito-urinary, 
126, 234; history of, 273; 
of the mind, 270; quality of, 
305; union in, 249, 260 

Surgical, meddlesomeness, 300; 
nursing, 271 

Sydenham, 91 

Sylvester II, 134 

Sylvius, 2 

Symmachus, 428 

Synanche, 332 

Taddeo AMerotti, 212, 215, 232 

Talmud, 11, 63, 65, 94 

Tarsus, 135 

Tartar, 321 

Tattooing, 31 

Taxes, 298 

Technique, Surgical, 125 

Teleology, 27, 95 

Tell a apple, 364 

Tenaculum, 258, 330 

Terence, 4, 190 

Tertullian, 27 

Testament, Old, 11 

Thaddaeus Florentinus, 130 

Thecla, 180 

Theodoret, 27 

Theodoric, 245, 252, 267, 273, 

Theodosia, 10, 181 

Theodotos, 26 

"Theology and Science," 419 

Theophilus, 54, 55 

"Thirteenth Greatest of Centu 
ries," 433 

Thomas Cantimprato, 433 

Thompson, 358 

Thorax, 295 

Thymol, 50 

Titian, 360 

Toledo, 76, 170 

Tonnerre Hospital, 296 



Tonsils, 29 

Tooth powder, 321; replacement 

of, 322 

Tornamira, 312 
Toscanelli, 360 
Toulouse, 286 
Tours, 433 


Ugo da Lucca, 251, 295 

Ugo Senesis, 130 

Ulcer, eroding, 256 

Union by first intention, 254 

Universitas, 203 

Universities, ecclesiastical, 210; 

medieval, 411 
University of Bologna, 142; of 

Paris, 887, 142, 199; of 

Salerno, 142 

University man, typical, 307 
Urine, 19 

Urination, difficulty of, 334 
Uvula, 118, 259, 332; removal 

of, 333 

Valentine, 20, 349; bibliogra 
phy, 376 

Valesco de Taranta, 312 

Van Helmont, 365 

Varices, 34 

Varicose veins, 127 

Varignana, 130 

Varolius, 2, 209, 327 

Vasari, 360 

V lum PaJati. 137 

Venerable Bede, 432 

Venesection, 104 

Vercelli, 248 

Verneuil, 303 

Verney, Francis, 311 

Verona, 248 

Vesalius, 2, 120, 204, 209, 233, 
289, 327 

Vicenza, 16, 232, 248 

Victoria, 180 

Vigo, John De, 334 

Villani, 313 

Vincent of Beauvais, 433 

Virchow, 297 

Virgil, 4 

Vitality, natural, 116 

Volta, 209 

Von Leyden, 336 


" Warfare of Science and Reli 
gion," 434 

Washington s hatchet, 364 

Water clock, 341 

Water in the ear, 48 

Watering places, 47 

Wenceslaus, Emperor, 424 

Whewell, 410 

White, Pres., 424 

Wine for wounds, 187 

William of Auvergne, 108 

William of Briscia, 268 

William of Salicet, 245, 256, 

William the Conqueror, 145 

Wimpheling, 361 

Wives as nurses, 272 

Women professors, 15 

Women physicians, 177, 179 

Wood hound, 435 

Wounds, penetrating, 250; ad 
hesion, 253; gunshot, 334; of 
intestines, 250; wine and oil, 

Wurtz, 254 

Yahia Ben Masoviah, 74 
Yard, 280 
Yperman, 276 
Ypres, 276 

Zedkias, 78 
Zenobia, 109 
Zoology, 418 

Other Books by Dr. Walsh 


phies of the men to whom we owe the important advances in 
the development of modern medicine. By James J. Walsh, 
M. D., Ph. D., LL. D., Dean and Professor of the History of Medi 
cine at Fordham University School of Medicine, N. Y. Second 
Edition, 1909. 362 pp. Price, $2.00 net. 

The London Lancet said : " The list is well chosen, and we have to 
express gratitude for so convenient and agreeable a collection of 
biographies, for which we might otherwise have to search through 
many scattered books. The sketches are pleasantly written, inter 
esting, and well adapted to convey the thoughtful members of our 
profession just the amount of historical knowledge that they would 
wish to obtain. We hope that the book will find many readers." 

The New York Times: "The book is intended primarily for stu 
dents of medicine, but laymen will find it not a little interesting." 

// Morgagni (Italy) : "Professor Walsh narrates important lives 
in modern medicine with an easy style that makes his book delight 
ful reading. It certainly will give the young physician an excellent 
idea of who made our modern medicine." 

The Lamp: "This exceptionally interesting book is from the prac 
ticed hand of Dr. James J. Walsh. It is a suggestive thought that 
all of the great specialists portrayed were God-fearing men, men 
of faith, far removed from the shallow materialism that frequently 
flaunts itself as inherently worthy of extra consideration for its 
own sake." 

The Church Standard (Protestant Episcopal) : " There is perhaps 
no profession in which the lives of its leaders would make more 
fascinating reading than that of medicine, and Dr. Walsh by his 
clever style and sympathetic treatment by no means mars the interest 
which we might thus expect." 

The New York Medical Journal: "We welcome works of this 
kind ; they are evidence of the growth of culture within the medical 
profession, which betokens that the time has come when our teachers 
have the leisure to look backward to what has been accomplished." 

Science: " The sketches are extremely entertaining and useful. 
Perhaps the most striking thing is that every one of the men de 
scribed was of the Catholic faith, and the dominant idea is that great 
scientific work is not incompatible with devout adherence to the 
tenets of the Catholic religion." 

THE POPES AND SCIENCE The story of the Papal Rela 
tions to Science from the Middle Ages down to the Nineteenth 
Century. By James J. Walsh, M. D . Ph.D., LL D. 440 pp. 
Price, $2.0O net. 

PROF. PAGEL, Professor of History at the University of Berlin: 
" This book represents the most serious contribution to the history 
of medicine that has ever come out of America." 

SIR CLIFFORD ALLBUTT, Regius Professor of Physic at the Uni 
versity of Cambridge (England) : "The book as a whole is a fair 
as well as a scholarly argument." 

The Evening Post (New York) says: "However strong the 
reader s prejudice * * * * he cannot lay down Prof. Walsh s volume 
without at least conceding that the author has driven his pen hard 
and deep into the academic superstition about Papal Opposition to 
science." In a previous issue it had said : " We venture to prophesy 
that all who swear by Dr. Andrew D. White s History of the War 
fare of Science with Theology in Christendom will find their hands 
full, if they attempt to answer Dr. James J. Walsh s The Popes 
and Science." 

The Literary Digest said : " The book is well worth reading for 
its extensive learning and the vigor of its style." 

The Southern Messenger says : " Books like this make it clear 
that it is ignorance alone that makes people, even supposedly edu 
cated people, still cling to the old calumnies." 

The Nation (New York) says: "The learned Fordham Physician 
has at command an enormous mass of facts, and he orders them 
with logic, force and literary ease. Prof. Walsh convicts his oppo 
nents of hasty generalizing if not anti-clerical zeal." 

The Pittsburg Post says : "With the fair attitude of mind and in 
fluenced only by the student s desire to procure knowledge, this 
book becomes at once something to fascinate. On every page 
authoritative facts confute the stereotyped statement of the purely 
theological publications." 

PROF. WELCH, of Johns Hopkins, quoting Martial, said : " It is 
pleasant indeed to drink at the living fountain-heads of knowledge 
after previously having had only the stagnant pools of second-hand 

PROF. PIERSOL, Professor of Anatomy at the University of Penn 
sylvania, said : " I have been reading the book with the keenest 
interest, for it indeed presents many subjects in what to me at least 
is a new light. Every man of science looks to the beacon truth 
as his guiding mark, and every opportunity to replace even time- 
honored misconceptions by what is really the truth must be wel 

The Independent (New York) said: "Dr. Walsh s books should 
be read in connection with attacks upon the Popes in the matter of 
science by those who want to get both sides." 

P. C. S., Sc. D. (London), Professor of Physics in Manhattan 
College, and James J. Walsh, M. D., Ph. D., Litt. D., Dean and 
Professor of the History of Medicine and of Nervous Diseases 
at Fordham University School of Medicine, New York Ford- 
ham University Press, 110 West 74th Street. Illustrated. 
Price, $2.00 net. Postage, 15 cents extra. 

The Scientific American: "One will find in this book very good 
sketches of the lives of the great pioneers in Electricity, with a 
clear presentation of how it was that these men came to make their 
fundamental experiments, and how we now reach conclusions in 
Science that would have been impossible until their work of reveal 
ing was done. The biographies are those of Peregrinus, Columbus, 
Norman and Gilbert, Franklin and some contemporaries, Galvini, 
Volta, Coulomb, Oersted, Ampere, Ohm, Faraday, Clerk Maxwell, 
and Kelvin." 

The Boston Globe: "The book is of surpassing interest." 

The New York Sun: "The researches of Brother Potamian 
among the pioneers in antiquity and the Middle Ages are perhaps 
more interesting than Dr. Walsh s admirable summaries of the 
accomplishment of the heroes of modern science. The book tes 
tifies to the excellence of Catholic scholarship." 

The Evening Post: " It is a matter of importance that the work 
and lives of men like Gilbert, Franklin, Galvini, Volta, Ampere and 
others should be made known to the students of Electricity, and this 
office has been well fulfilled by the present authors. The book is no 
mere compilation, but brings out many interesting and obscure facts, 
especially about th earlier men." 

The Philadelphia Record: " It is a glance at the whole field of 
Electricity by men who are noted for the thoroughness of their re 
search, and it should be made accessible to every reader capable of 
taking a serious interest in the wonderful phenomena of nature." 

Electrical World: "Aside from the intrinsic interest of its mat 
ter, the book is delightful to read owing to the graceful literary 
style common to both authors. One not having the slightest ac 
quaintance with electrical science will find the book of absorbing 
interest as treating in a human way and with literary art the life 
work of some of the greatest men of modern times ; and, moreover, 
in the course of his reading he will incidentally obtain a sound 
knowledge of the main principles upon which almost all present- 
day electrical development is based. It is a shining example of how 
science can be popularized without the slightest twisting of facts or 
distortion of perspective. Electrical readers will find the book also 
a scholarly treatise on the evolution of electrical science, and a 
most refreshing change from the engineering English of the 
typical technical writer." 

tures and Addresses on Phases of Education in the Past 
Which Anticipate Most of Our Modern Advances, by James 
J. Walsh, M.D., Ph.D., Litt. D., K. C. St. G., Dean and Pro 
fessor of the History of Medicine and of Nervous Diseases at 
Fordham University School of Medicine. Fordham University 
Press, 1910. 470 pp. Price, $2.00 net. Postage, 15 cents 

CARDINAL MORAN (Sydney, Australia) : "I have to thank you for 
the excellent volume Education, How Old the New. The lectures 
are admirable, just the sort of reading we want for English read 
ers of the present day." 

New York Sun: " It is all bright and witty and based on deep 

The North American (Philadelphia): "Wide historical research, 
clear graphic statement are salient elements of this interesting and 
suggestive addition to the modern welter of educational literature." 

Detroit Free Press: " Full of interesting facts and parallels drawn 
from them that afford much material for reflection." 

Chicago Inter-Ocean: "Incidentally it does away with a num 
ber of popular misconceptions as to education in the Middle A.ges 
and as to education in the Latin-American countries at a somewhat 
later time. The book is written in a straight, unpretentious an i in 
teresting style." 

Wilkes-Barre Record: "The volume is most interesting and 
shows deep research bearing the marks of the indefatigable student." 

Pittsburg Post: "There is no bitterness of controversy and one 
of the first things to strike the reader is that the dean of Fordham 
quotes from nearly everybody worth while, Protestant or Catholic, 
poetry, biography, history, science or what not." 

The Wall Street News (New York) : "The book is calculated to 
cause a healthy reduction in the conceit which each generation en 
joys at the expense of that which preceded it." 

Rochester Post Express: "The book is well worth reading." 

The New Orleans Democrat: "The book makes very interesting 
reading, but there is a succession of shocks in store in it for the 
complacent New Englander or Bostonian and for the orthodox or 
perfunctory reader of American literature." 


The highest value attaches to historical research on the lines you 
so ably indicate, especially at the present time, when the enemies of 
Holy Church are making renewed efforts to show her antagonism to 
science and human progress generally. I shall have much pleasure 
in perusing your work entitled " The Thirteenth Greatest of Cen 

Wishing you every blessing, I am, Yours sincerely in Xt., 

Rome, January i8th, 1908. 

Jas. J. Walsh, Esq., New York. 

James J. Walsh, M D Ph. D.. Litt. D Dean and Professor of 
Nervous Diseases and of the History of Medicine at Fordham 
University School of Medicine; Professor of Physiological 
Psychology at Cathedral College, New York. Catholic Sum 
mer School Press. 110 West 74th Street, N. Y., Georgetown 
University Edition. Over 100 additional illustrations and 
twenty-six chapters that might have been, nearly 600 pages. 
Price, $3.50, post free. 

PROF. WILLIAM QSLER, of Oxford, delivering the Linacre Lecture 
before the University of Cambridge, said : " That good son of the 
Church and of the profession, Dr. James J. Walsh, has recently 
published a charming book on The Thirteenth as the Greatest of 
Centuries. He makes a very good case for what is called the First 

The Saturday Review (of London) : " The volume contains a 
mass of interesting facts that will start a train of profitable 
thought in many readers minds." 

The Educational Review said : " The title of Dr. Walsh s book, 
The Thirteenth Greatest of Centuries, will startle many readers, but 
we respectfully commend to the open-minded his presentation of 
that great epoch. A century that witnessed such extraordinary 
achievements in architecture, in arts and crafts, in education, and in 
literature and law, as did the Thirteenth, is not to be lightly dis 
missed or unfavorably compared with periods nearer our own." 

The Pittsburg Post said: "Dr. Walsh writes infused with all the 
learning of the past, enthusiastic in modern research, and sympa 
thetic, in true scholarly style, with investigation in every line. One 
need only run over a few of the topical headings to feel how 
plausible the thesis is. The assemblage of the facts and the elucida 
tion of their mutual relations by Dr. Walsh shows the master s 
skill. The work bristles on every page with facts that may be 
familiar to many, but which were never before so arranged in just 
perspective with their convincing force so clearly shown." 

CARDINAL MORAN. of Sydney, Australia : " Just the sort of litera 
ture we want for English readers at the present day."